The Rosacea Forum: Papulopustular,
Telangiectatic, and Phymatous Subtypes

In certain cases, the papulopustular and telangiectatic components of rosacea are unresponsive to traditional antibiotics treatments. In a recent study, Larson AA, Goldman MP, in conjunction with Dermatology Section of Dartmouth-Hitchcock Medical Center in Lebanon, NH, have presented a case that was unresponsive to treatment with antibiotics.
In response, they utilized the multiplexed laser for treatment of both papular and telangiectatic (for telangiectasias relating to varicose veins disease, please see this site) rosacea with success. Laser treatment of the redness and telangiectatic components of rosacea has recently been very popular. Dr. Eric Bernstein has demonstrated highly effective results with his treatment with laser. Does anyone have any results, or experiences with recalcitrant rosacea being treated with laser therapy?

The information found on this website is not designed to replace the patient/physician relationship.

For many years the tetracycline drugs have been prescribed for sufferers of rosacea, though we were not exactly sure why these drugs were effective. The conventional wisdom has been that this class of drugs works on rosacea due to its anti-inflammatory properties, as well as having some impact on papulopustular rosacea and its associated acne-like symptoms.

CollaGenex Pharmaceuticals Inc of Newtown, PA., has now published a study by Theobald K, Bradshaw M, and Leyden J. demonstrating the efficacy of a 40-mg controlled-release formulation of doxycycline in the treatment of rosacea, a dose well below the conventional level of 100 to 200 mg/d. Since no formal dose-response studies have been conducted, the authors analyzed phase 3 data to determine whether a dose-efficacy relationship exists.

Their methods involved standard parametric regression analyses were used to estimate the correlations between dose (mg/kg body weight) and overall drug exposure (area under the curve [AUC]) in a phase 1 pharmacokinetic study and between dose and efficacy (mean change from baseline in total inflammatory lesion count at week 16) in 2 pooled phase 3 clinical efficacy studies. Additional regressions were run at each visit for the clinical efficacy studies to determine whether results differed across visits. A regression analysis was also performed in a subset of patients who showed a greater efficacy response. Results. We found overall drug exposure (AUC) to have a highly significant correlation with dose (mg/kg) (r=0.49; P=.006). In contrast, clinical efficacy did not correlate with dose at any of the visits at week 3 (r=0.01; P=.85), week 6 (r=0.04; P=.53), week 12 (r<0.01; P=.98), and week 16 (r=0.03; P=.64) or among the subset of patients who showed greater clinical benefit.

Their conclusions are that higher doses did not lead to any increased efficacy. Their results showed that 40-mg controlled-release formulation conferred peak anti-inflammatory efficacy in the treatment of rosacea

Has anyone seen anecdotal evidence to support this? Or counter it?

Thanks for your comments.

The information found on this website is not designed to replace the patient/physician relationship.

Welcome fellow dermatologists! Finally we have a physician resource to discuss our experiences treating, managing and understanding Rosacea. We have established this forum as a place for us to interact, deposit knowledge and methods, observations, and advice from a physician’s point of view.

Rosacea is a complex and often misdiagnosed condition. Management of symptoms and treatment recommendations can be contentious and hotly debated. Our hope is that by created a resource for physicians internationally, we may all garner a greater understanding of what is needed and what is possible in our research and treatment of this condition.

We invite visitors to post and physicians to join our blog roll. Eventually this site will become a quality resource for patients as well.

Best Regards,
The Moderators

The information found on this website is not designed to replace the patient/physician relationship.