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Review
. 2023 Dec;13(12):2933-2949.
doi: 10.1007/s13555-023-01048-1. Epub 2023 Oct 12.

Emerging Medical Therapies in Rosacea: A Narrative Review

James Choe  1 , John S Barbieri  2
Affiliations
Review

Emerging Medical Therapies in Rosacea: A Narrative Review

James Choe et al. Dermatol Ther (Heidelb). 2023 Dec.

Abstract

Rosacea is a chronic inflammatory disease with a multifactorial pathogenesis. The wide spectrum of clinical phenotypes, including erythema, telangiectasia, inflammatory papules and pustules, and phyma, demand an individualized approach to treatment. This narrative review offers an updated reference for rosacea management by covering the latest developments in both topical and systemic treatments, including data from newly approved therapies, updates to current treatment modalities and ongoing clinical trials. Although use of benzoyl peroxide as a treatment for rosacea has typically been limited due to irritation, the improved tolerability due to microencapsulation of benzoyl peroxide 5% cream provides a new therapeutic option for patients with rosacea. Minocycline foam and topical ivermectin cream add to our armamentarium of treatment options, particularly for inflammatory papules and pustules. Sarecycline has a narrower spectrum of antibacterial activity, which might reduce the development of antibiotic resistance and disruption of the microbiome compared to other oral antibiotics. Brimonidine gel and oxymetazoline cream provide topical options for redness and flushing. There is emerging evidence about the role of hydroxychloroquine and intradermal botulinum toxin A, which may improve rosacea through their effects on mast cells. The clinical trials pipeline includes agents with a variety of mechanisms, including mast cell stabilization, antimicrobial, anti-inflammatory, and vasoconstrictive effects. However, the clinical pipeline for rosacea appears limited, and there remain important unmet needs for patients with more recalcitrant rosacea or phymatous disease. In addition, there is a need for comparative effectiveness studies to identify the highest value treatment approaches for patients with rosacea.

Keywords: Benzoyl peroxide; Botulinum toxin; Brimonidine; Hydroxychloroquine; Ivermectin; Microencapsulation; Minocycline; Oxymetazoline; Rosacea; Sarecycline.

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Conflict of interest statement

John S. Barbieri has received consulting fees from Dexcel Pharma for work unrelated to the present study. James Choe has nothing to disclose.

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References

    1. Steinhoff M, Schauber J, Leyden JJ. New insights into rosacea pathophysiology: a review of recent findings. J Am Acad Dermatol. 2013;69:S15–26. doi: 10.1016/j.jaad.2013.04.045. - DOI - PubMed
    1. Mc Aleer MA, Lacey N, Powell FC. The pathophysiology of rosacea. G Ital Dermatol Venereol. 2009;144:663–671. - PubMed
    1. Schaller M, Almeida LMC, Bewley A, et al. Recommendations for rosacea diagnosis, classification and management: update from the global ROSacea COnsensus 2019 panel. Br J Dermatol. 2020;182:1269–1276. doi: 10.1111/bjd.18420. - DOI - PMC - PubMed
    1. Oussova T, New drug application approval letter for Epsolay (benzoyl peroxide) cream. US Food and Drug Administration. April 22, 2022. https://www.accessdata.fda.gov/drugsatfda_docs/appletter/2022/214510Orig.... Accessed 20 July 2023.
    1. Sugarman J, Baldwin H, Bhatia N. Efficacy of microencapsulated benzoyl peroxide (E-Bpo) cream, 5% in elderly rosacea patients. SKIN J Cutan Med. 2021;5:s27–s27. doi: 10.25251/skin.5.supp.27. - DOI

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