Efficacy of Treatments in Reducing Facial Erythema in Rosacea: A Systematic Review

Abstract

Rosacea is a chronic inflammatory skin condition that affects over 5% of individuals worldwide. Its clinical presentation is characterized by an array of features, including erythema, papules and pustules, phymatous changes, telangiectasia, and ocular manifestations. Specifically, the multifaceted manifestation of erythema varies widely in intensity and distribution. Factors contributing to pathogenesis include neurovascular dysregulation, increased levels of pro-inflammatory mediators, and aberrant vasodilation. Erythema management plays an important role in reducing the psychosocial burden associated with rosacea and improving overall quality of life. Cochrane CENTRAL, Medline, and Embase databases were searched from inception to September 2023 and included 33 clinical trials reporting on a total of 7411 rosacea patients (74.1% female) and 21 different topical or systemic treatments. The mean age was 48.8 years (range, 18-83 years), and the mean time to outcome assessment was 8.1 weeks (standard deviation, 4.1 weeks). Treatment efficacy was assessed by outcome measures including percent improvement from baseline on 4- and 5-point scales, clinician erythema assessment (CEA) success (improvement ≥1 point), and CEA and patient self-assessment success (improvement ≥1 point). Pooled effect sizes for each treatment were calculated as a weighted average based on the number of patients in each study. The most effective topical treatments for reducing erythema include sodium sulphacetamide and sulphur, praziquantel, metronidazole, and B244 spray (Nitrosomonas eutropha). The most effective systemic treatment was paroxetine. Our findings highlight the varying efficacy of treatments in addressing the erythema in rosacea, recognizing the nuances of clinical presentations.

Keywords: erythema; rosacea; treatment.

Figure 1.

Efficacy of treatment regimens in improving erythema when measured on a 4-point scale in rosacea patients. The mean percent improvement in erythema score is represented by the bullet for each treatment. Bars represent standard deviations. SS, sodium sulphacetamide.

Figure 2.

Efficacy of treatment regimens in improving erythema when measured on a 5-point scale in rosacea patients. The mean percent improvement in erythema score is represented by the bullet for each treatment. Bars represent standard deviations.

Figure 3.

Efficacy of treatment regimens in improving erythema when measured in terms of CEA success (≥1 point improvement) in rosacea patients. The mean percent of patients achieving CEA success is represented by the bullet for each treatment. Bars represent standard deviations. CEA, clinician erythema assessment.

Figure 4.

Efficacy of treatment regimens in improving erythema when measured in terms of CEA and PSA success (≥1 point improvement) in rosacea patients. The mean percent of patients achieving CEA and PSA success is represented by the bullet for each treatment. Bars represent standard deviations. CEA, clinician erythema assessment; PSA, patient self-assessment.