Efficacy of Treatments in Reducing Inflammatory Lesion Counts in Patients With Rosacea

Rosacea is a common inflammatory skin disease that involves neurovascular dysregulation affecting the skin and eyes. The disease can present a significant burden to patients. The diagnostic features include phymatous changes or persistent erythema. The major features include papules and pustules, transient erythema, and telangiectasias, and the minor features include abnormal sensations of the skin, including stinging or burning. Effective treatment involves targeting each of the individual features presented by the patient. Treatment generally requires a balance of good efficacy and good tolerability.

This systematic review looked at both topical and systemic monotherapies and their effect on inflammatory lesion counts. Clinical trials that had a vehicle/placebo arm were included. The results were reported in terms of the percent reduction in inflammatory lesion counts and fold reduction compared with vehicle/placebo.

The authors state that the National Institutes of Health quality-assessment tool was used to assess the methodological quality, which provides quality ratings of "good," "fair," and "poor," and only reports with a "good" rating were included. However, studies with 40 or fewer total patients were given the same weight as large, prospective, phase III, reproducible clinical trials. Based on the authors' analysis, isotretinoin was the most effective systemic medication, and adapalene 0.1% was the most effective topical medication. All of the FDA-approved treatments were considerably less effective.

Although this is an interesting analysis, the treatment of rosacea is much more complex than simply counting inflammatory lesions. The tolerability of the medication, especially topical formulations, is critical. The skin barrier is often compromised in patients with rosacea, and the side effects of the treatment can affect compliance. A holistic approach to treating rosacea is the best approach.