New Horizons in Rosacea TreatmentCraig Kraffert, MD
As discussed in my last post, rosacea is a condition with multiple contributory factors, many of which are still being discovered through scientific investigation. Medical understanding of the many facets of rosacea is growing incrementally clearer each year.
With a greater understanding of the disorder, Rosacea therapy has advanced substantially over the past twenty years. Still, there is much room for improvement for specific rosacea-related situations. Oral and topical antibiotics and azelaic acid gels are currently the mainstay of modern rosacea therapy. Still, for some, these therapies are unsatisfactory. Thus the hunt for new rosacea treatment options continues. Presently, there are three rosacea treatment developments of particular interest. Two of these treatments address rosacea-related (and often treatment-resistant) diffuse facial redness. The third treatment is a tried-and-true treatment for many rosacea symptoms that is generating renewed medical interest.
When Traditional Therapies Aren’t Enough
One of the most common concerns of rosacea sufferers is persistent redness and flushing. Laser can certainly help with redness when the blood vessels are large enough to treat; however, diffuse redness resists laser treatment as well as traditional topical and oral rosacea therapies. At last, therapies that address this unmet need are on the horizon: one oral agent and one topical application.
A recent study of eleven patients in Taiwan demonstrated the potential of oral carvedilol in the treatment of redness from rosacea. Carvedilol, a beta blocker traditionally used in the treatment of heart weakness, provided significant rosacea redness relief for all eleven patients. Only one patient discontinued therapy due to side effects. Carvedilol is currently available in generic form in the United States. It is likely that more study of this treatment option, both formally and informally, will occur in the coming years.
There is also an anticipated FDA approval of a topical treatment option for the redness of rosacea. This product will likely reach the market within the next two years. Galderma Laboratories has completed phase 3 studies of brimonidine tartrate 0.5% gel. When applied once daily, brimonidine has been shown to be safe and effective in the treatment of severe persistent facial redness associated with rosacea. This novel therapy for rosacea redness is likely to find a large market, as it appears to be a viable topical treatment option for an essentially unmet medical need.
Sulfur in the Spotlight for Rosacea Therapy
Sulfur is also in the spotlight of rosacea treatment options – again. Sulfur was first described in the treatment of skin disease in Egypt in 1550 BC. Koreans have also used sulfur in skin care for centuries. Western use of sulfur in rosacea dates to the mid 1800s and became popular in the United States during the last fifty years. Sulfur is safe, effective and underused in the treatment of rosacea. It is antiseptic, antibacterial and antifungal. In addition, sulfur kills the undesirable Demodex mites described in my prior post. The key issue with sulfur is its tendency to produce an odor, though more sophisticated formulations suffer less from this problem.
Like many medical disorders, our understanding of rosacea as a disease entity and the development of more and better treatment options for it are moving forward – slowly and steadily.