Combination therapies often needed in rosacea treatment
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MIAMI BEACH, Fla. — Rosacea is often a combination disease requiring combination therapies, according to a speaker here.
“We’ve been talking about rosacea subtypes for a very, very long time, but we know that virtually every patient we see walk through the door is a combination,” Hilary Baldwin, MD, medical director at the Acne Treatment & Research Center and clinical associate professor at Rutgers Robert Wood Johnson Medical Center, said during a presentation at South Beach Symposium. “For the past 10 years, we’ve been shying away from subtypes and talking about phenotypes.”
Rosacea is often a combination disease requiring combination therapies.
In doing this, thinking about therapies is also important because more than one medication or treatment option is likely necessary to address all phenotypes a patient is experiencing.
“The drugs for papules and pustules do not work for erythema and the drugs for erythema do not work for papules and pustules,” Baldwin said. “So, the patient with combination disease needs two, at least, medications or medication plus a procedure in order to get better. This is a big deal for a patient.”
Medications that have had great efficacy for papules and pustules include ivermectin, minocycline foam and microencapsulated benzoyl peroxide cream.
Ivermectin has shown nearly 40% of patient achieving clear or almost clear skin at week 12 compared with 11.6% of patients treated with vehicle, whereas patients treated with minocycline 1.5% foam had an approximately 60% decrease in inflammatory lesion count at week 12, according to Baldwin.
The minocycline foam-treated patients also had a rapid onset of efficacy.
“It’s a real jack-rabbit start these new drugs have,” Baldwin said. “That’s really important because when a drug works fast you have a happy patient and a happy patient is a happy doc.”
Microencapsulated benzoyl peroxide 5% also had a reduction in inflammatory lesions of about 70% in clinical trials, with an approximate 40% reduction in the first 2 weeks.
For patients with vascular disease, the different types of redness must be evaluated to pick the right treatment agents.
“For persistent facial erythema, which is the hallmark of rosacea, we can use the alpha agonist,” Baldwin said. “But flushing does not respond to the alpha agonists and we might have to break out the beta blockers.”
For perilesional erythema, the lesions mut be treated, while energy-based therapies are needed for telangiectasia.
“You may have a patient who requires all of these things in order to control just the redness of their skin,” Baldwin said.
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Baldwin H. What’s new in topicals for acne and rosacea. Presented at: South Beach Symposium; Feb. 9-12, 2023; Miami Beach, Fla.
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