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. 2024 Jul-Aug;28(4):352-359.
doi: 10.1177/12034754241253195. Epub 2024 May 28.

Efficacy of Treatments in Reducing Inflammatory Lesion Count in Rosacea: A Systematic Review

Ryan S Q Geng  1 , Siddhartha Sood  1 , Nicholas Hua  1 , Jennifer Chen  1 , Ronald G Sibbald  2 , Cathryn Sibbald  3
Affiliations

Efficacy of Treatments in Reducing Inflammatory Lesion Count in Rosacea: A Systematic Review

Ryan S Q Geng et al. J Cutan Med Surg. 2024 Jul-Aug.

Abstract

Introduction: Rosacea is a chronic inflammatory skin condition affecting approximately 5.5% of the global population. Patients present heterogeneously with a mix of features in the central facial region, of which papules and pustules are considered to be a major feature. The identification of effective treatments for reducing inflammatory lesions in rosacea can alleviate the psychosocial burden that many rosacea patients experience, including reduced self-esteem, anxiety, and social withdrawal. The objective of this systematic review is to determine the effectiveness of topical and systemic therapies in reducing lesion count in rosacea patients.

Methods/results: Medline, Embase, and Cochrane CENTRAL databases were searched, resulting in the inclusion of 43 clinical trials reporting on a total of 18,347 rosacea patients. The most well-studied treatments include ivermectin, metronidazole, azelaic acid, minocycline, and doxycycline. Oral isotretinoin was the most effective treatment in reducing inflammatory lesions and may be recommended for severe recalcitrant cases of rosacea.

Conclusions: Several topical and systemic therapies have demonstrated efficacy in reducing inflammatory lesion count in rosacea patients, with mechanisms of action centred around suppressing inflammation and killing Demodex folliculorum mites. Additional research is required to determine effective combination therapies in rosacea.

Keywords: demodex; inflammatory lesions; rosacea.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: CS has received honoraria from Abbvie, Leo, Pfizer, Miravo, Novartis, UCB, Sanofi/Regeneron unrelated to this work. RGS has received honoraria from Perfuse, Quart Medical, Novartis, Medexus Pharmaceuticals Canada along with Ontario Gov’t (Project ECHO Ontario Skin and Wound—Ministry of Health and Micro-credentials—through Ministry of Colleges and Universities and Sault College all unrelated to this work. RSQG, SS, NH, and JC have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.
Figure 2.
Figure 2.
Efficacy of treatment regimens in reducing IL count in rosacea patients. The mean percent reduction in ILs is represented by the bullet for each treatment. Bars represent standard deviations. BPO, benzoyl peroxide; IL, inflammatory lesion; SS, sodium sulfacetamide.
See this image and copyright information in PMC

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