Acne rosacea – what gels and ointments do dermatologists prescribe?

Rosaceous acne is an inflammatory skin condition of a chronic nature with an unknown cause. It is characterised by erythema, papules, pustules and often affects the eyes and nose. The symptoms are characteristic, but it is important not to diagnose the disease on your own by comparing your skin with pictures from the internet. Nor is the advice of a beautician or cosmetologist enough. To get a diagnosis, you need to visit a dermatologist.

 

What gels and ointments do dermatologists most commonly recommend? For the treatment of rosacea, the US drug approval agency Food and Drug Administartion (FDA) has approved three topical medications that are used successfully worldwide:

• 0.75% and 1% metronidazole gel,
• 10% sodium sulfacetamide with 5% sulphur
• and 15% azelaic acid – are indicated in the treatment of papules, pustules and erythema.

Other therapeutic options used worldwide include:

• antifungal erythromycin, clindamycin and benzoyl peroxide
• the non-steroidal immunomodulatory agent Taktrolimus – its effect on rosacea is little studied, it is mainly a drug for atopic dermatitis
• retinoid Tretinoin – also little studied

First choice drug – metronidazole for the treatment of rosacea

Metronidazole is the first choice drug for the treatment of rosacea. It has a bactericidal effect on anaerobic microorganisms – protozoa as well as bacteria. There has been a long period of research into the dosage of the drug, at first it was thought that a more desirable configuration was to use the gel twice daily at the lower concentration of 0.75%, but after studies on probands, the better efficacy of the drug at 0.75%-1% once daily was proven. In the trials, patients rarely reported side effects of the treatment used, the least reported being with the new 1% gel formulation. The efficacy of metronidazole therapy is comparable to that of azelaic acid therapy 15%.

 

Alternatives – sodium sulfacetamide and sulphur

For the past 50 years, sodium sulafamide and sulphur treatment at a concentration of 5% has been most commonly used despite there being little research or literature on the subject. Nowadays, this drug combination is recommended in a new ‘wash in wash off’ formulation in combination with metronidazole. The mechanism of action of sodium sulphamide in combination with sulphur is not yet well understood. Sulfacetamide is used in the treatment as an antimicrobial agent and sulphur as an antifungal, keratolytic component against Demodex folliculorum (boil). In Poland, preparations containing sulfacetamide are available as eye drops.

 

Effective azelaic acid

Azelaic acid was approved by the FDA for the treatment of rosacea in 2002. In dermatology, it is most commonly used as a 15% gel and 20% cream. Its antibacterial, antiseptic properties are also used in the treatment of juvenile acne and adult acne. Azelaic acid also exhibits anti-epidermal and keratolytic activity and reduces post-inflammatory hyperpigmentation. Gel formulations available on the Polish market include Skinoren 15% and Finacea 15%. Various clinical studies have shown greater efficacy of azelaic acid-based therapies compared to metronidazole, but at the cost of a higher number of reported skin irritations.

Topical treatment is also complemented by oral treatment, about which more shortly.