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. 2019 Jul;181(1):65-79.
doi: 10.1111/bjd.17590. Epub 2019 Mar 10.

Interventions for rosacea based on the phenotype approach: an updated systematic review including GRADE assessments

E J van Zuuren  1 , Z Fedorowicz  2 , J Tan  3 , M M D van der Linden  4 , B W M Arents  5 , B Carter  6   7 , L Charland  8
Affiliations

Interventions for rosacea based on the phenotype approach: an updated systematic review including GRADE assessments

E J van Zuuren et al. Br J Dermatol. 2019 Jul.

Abstract

Background: Rosacea is a common chronic facial dermatosis. Classification of rosacea has evolved from subtyping to phenotyping.

Objectives: To update our systematic review on interventions for rosacea.

Methods: We searched CENTRAL, MEDLINE, Embase, LILACS, Science Citation Index and ongoing trials registers (March 2018) for randomized controlled trials. Study selection, data extraction, risk-of-bias assessment and analyses were carried out independently by two authors. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was used to assess certainty of evidence.

Results: We included 152 studies (46 were new), comprising 20 944 participants. Topical interventions included brimonidine, oxymetazoline, metronidazole, azelaic acid, ivermectin and other topical treatments. Systemic interventions included oral antibiotics, combinations with topical treatments or other systemic treatments. Several studies evaluated laser or light-based treatment. We present the most current evidence for rosacea management based on a phenotype-led approach.

Conclusions: For reducing temporarily persistent erythema there was high-certainty evidence for topical brimonidine and moderate certainty for topical oxymetazoline; for erythema and mainly telangiectasia there was low-to-moderate-certainty evidence for laser and intense pulsed light therapy. For reducing papules/pustules there was high-certainty evidence for topical azelaic acid and topical ivermectin; moderate-to-high-certainty evidence for doxycycline 40 mg modified release (MR) and isotretinoin; and moderate-certainty evidence for topical metronidazole, and topical minocycline and oral minocycline being equally effective as doxycycline 40 mg MR. There was low-certainty evidence for tetracycline and low-dose minocycline. For ocular rosacea, there was moderate-certainty evidence that oral omega-3 fatty acids were effective and low-certainty evidence for ciclosporin ophthalmic emulsion and doxycycline.

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Conflict of interest statement

E.J.v.Z. serves on the global ROSacea COnsensus panel (ROSCO) and received nonfinancial support and other support from Galderma in October 2016. J.T. has been an advisor, consultant, investigator and/or speaker for Allergan, Bayer, Cipher, Galderma and Valeant. J.T. was a co‐author of the Canadian Rosacea Clinical Practice Guidelines and is the co‐chair of ROSCO and serves on the expert panel of the National Rosacea Society. J.T. was an investigator in the following trials: Stein et al.,164 Stein Gold et al.,41 Stein Gold et al.42 and Tan et al.131 M.M.D.v.d.L. received nonfinancial support and other support from Galderma in October 2016, and received speaker fees from Janssen Cilag and AbbVie. Furthermore, M.M.D.v.d.L. was an investigator in the following trial: van der Linden MMD et al.43

Figures

Figure 1
Figure 1
Study flowchart.
Figure 2
Figure 2
Risk‐of‐bias summary.
See this image and copyright information in PMC

Comment in

References

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