Rosacea: New Concepts in Classification and Treatment

Zuuren, Esther J van; Arents, B.W.M.; Linden, M.M.D. van der; Vermeulen, Sofieke; Fedorowicz, Zbys; Tan, Jerry

doi:10.1007/s40257-021-00595-7

Cited by 133 publications

(175 citation statements)

References 42 publications

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“…Common and notable adverse events included upper (14) and viral respiratory tract infection (14), sinusitis (9), and pruritus (1) 110 . Minocycline 1.5% foam has been Food and Drug Administration (FDA) approved 3 …”

Section: Diagnosis and Classificationmentioning

confidence: 99%

“…Effective therapies can improve the lives of patients with rosacea. Advances in understanding rosacea pathophysiology have provided insight into mechanisms of current treatments and will provide guidance in developing future interventions 3 . Multiple recent publications have reviewed the evidence for rosacea treatments and contextualized them into recommendations 4,5 .…”

Section: Introductionmentioning

confidence: 99%

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Rosacea treatments: Current standards and additional options

Tan

Singh

Song

et al. 2021

Dermatological Reviews

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Background Rosacea, a chronic facial and ocular inflammatory disease, is readily visible with consequential adverse psychosocial impacts. Progress in epidemiology, pathophysiology, treatments, psychosocial and quality of life impact has led to improved outcomes. Additionally, there has been a transition to updated clinical criteria for diagnosis and classification, the phenotype approach, based on rosacea‐associated features. Objective Our objective was to identify current evidence‐based standards of treatment for rosacea highlighting recently approved interventions and including innovative options. Methods Reviews establishing current standards of care published over the past three years and English language clinical studies of rosacea treatment from 2018‐ March 2021 were included. In addition to pivotal trials, the latter were also selected based on innovation and practicality of the intervention. Results In addition to treatments identified in guidelines and systematic reviews, additional options derive from use in other dermatological conditions ‐ such as botulinum toxin, hydroxychloroquine, photodynamic therapy, radiofrequency with or without microneedling ‐ or from other medical conditions, such as artemether and sumatriptan. Conclusion We provide a template of longitudinal care for rosacea based on features divided into current standards and additional options. The latter may provide the impetus for further research and development to provide options with greater efficacy, longer remissions and/or lower risk of adverse events to improve outcomes in patients with rosacea.

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Section: Diagnosis and Classificationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Rosacea treatments: Current standards and additional options

Tan

Singh

Song

et al. 2021

Dermatological Reviews

Self Cite

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“…The histopathologic features of erythematotelangiectatic rosacea are telangiectasia with lymphohistiocytic perifolliculitis, vascular ectasia, and solar elastosis. 3 …”

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confidence: 99%

“…Other treatment options include topical azelaic acid, topical vasoconstrictors, and laser therapy. 3 …”

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confidence: 99%

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A chronic nonresponsive facial eruption

Saikaly

Motaparthi

2021

JAAD Case Reports

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A 67-year-old woman presented for evaluation of a waxing and waning facial eruption, which had been present for several years. Of note, the patient denied any prior use of topical steroids. The patient took omeprazole daily for years but denied any correlation with her cutaneous eruption. Physical examination revealed erythematous atrophic plaques and thin plaques with scale on the bilateral cheeks within a diffuse background of telangiectasia (Fig 1 ½F1 ). Dermoscopic evaluation did not reveal follicular plugging. Prior laboratory evaluation by her primary care physician demonstrated absence of antinuclear antibodies and anti-dsDNA antibodies, and low levels of C3 and C4 Q6. A punch biopsy revealed cell-poor interface dermatitis with scattered apoptotic keratinocytes, along with superficial perivascular and perifollicular lymphoplasmacytic infiltrate (Fig 2 ½F2 ).

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Erenumab for Treatment of Persistent Erythema and Flushing in Rosacea

Wienholtz,

Christensen,

et al. 2024

JAMA Dermatol

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ImportanceTreatment of erythema and flushing in rosacea is challenging. Calcitonin gene-related peptide (CGRP) has been associated with the pathogenesis of rosacea, raising the possibility that inhibition of the CGRP pathway might improve certain features of the disease.ObjectiveTo examine the effectiveness, tolerability, and safety of erenumab, an anti–CGRP-receptor monoclonal antibody, for the treatment of rosacea-associated erythema and flushing.Design, Setting, and ParticipantsThis single-center, open-label, single-group, nonrandomized controlled trial was conducted between June 9, 2020, and May 11, 2021. Eligible participants included adults with rosacea with at least 15 days of either moderate to severe erythema and/or moderate to extreme flushing. No concomitant rosacea treatment was allowed throughout the study period. Visits took place at the Danish Headache Center, Copenhagen University Hospital, Rigshospitalet in Copenhagen, Denmark. Participants received 140 mg of erenumab subcutaneously every 4 weeks for 12 weeks. A safety follow-up visit was performed at week 20. Data analysis occurred from January 2023 to January 2024.Intervention140 mg of erenumab every 4 weeks for 12 weeks.Main Outcomes and MeasuresThe primary outcome was mean change in the number of days with moderate to extreme flushing during weeks 9 through 12, compared with the 4-week run-in period (baseline). The mean change in number of days with moderate to severe erythema was a secondary outcome. Adverse events were recorded for participants who received at least 1 dose of erenumab. Differences in means were calculated with a paired t test.ResultsA total of 30 participants (mean [SD] age, 38.8 [13.1] years; 23 female [77%]; 7 male [23%]) were included, of whom 27 completed the 12-week study. The mean (SD) number of days with moderate to extreme flushing was reduced by −6.9 days (95% CI, −10.4 to −3.4 days; P &lt; .001) from 23.6 (5.8) days at baseline. The mean (SD) number of days with moderate to severe erythema was reduced by −8.1 days (95% CI, −12.5 to −3.7 days; P &lt; .001) from 15.2 (9.1) days at baseline. Adverse events included transient mild to moderate constipation (10 participants [33%]), transient worsening of flushing (4 participants [13%]), bloating (3 participants [10%]), and upper respiratory tract infections (3 participants [10%]), consistent with previous data. One participant discontinued the study due to a serious adverse event (hospital admission due to gallstones deemed unrelated to the study), and 2 participants withdrew consent due to lack of time.Conclusions and RelevanceThese findings suggest that erenumab might be effective in reducing rosacea-associated flushing and chronic erythema (participants generally tolerated the treatment well, which was consistent with previous data), and that CGRP-receptor inhibition holds potential in the treatment of erythema and flushing associated with rosacea. Larger randomized clinical trials are needed to confirm this finding.Trial RegistrationClinicalTrials.gov Identifier: NCT04419259

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Rosacea: New Concepts in Classification and Treatment

Cited by 133 publications

References 42 publications

Rosacea treatments: Current standards and additional options

Rosacea treatments: Current standards and additional options

A chronic nonresponsive facial eruption

Erenumab for Treatment of Persistent Erythema and Flushing in Rosacea

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