In a comprehensive review published in the Journal of Cosmetic Dermatology, researchers describe the various treatments currently available to manage rosacea, including oral and topical agents, laser and light therapies, and skin care routines like sunscreen application and use of moisturizing agents and makeup.
[Refocusing on rosacea. Experts reexamine the disease’s classification inDermWorld.]
Topical agents include azelaic acid (15%) gel for mild-to-moderate rosacea. The researchers state that previous investigations have found that azelaic acid (15%) gel and (20%) cream are equally effective in the management of papulopustular rosacea. Metronidazole (0.75%) in a gel, cream, and lotion, as well as 1% cream and gel are also effective. The 1% cream (once daily) is associated with significant reductions in erythema and inflammatory lesions. Other first-line topical options discussed include sodium sulfacetamide/sulfur (10%/5%), brimonidine tartrate (0.33%) gel, oxymetazoline hydrocholoride (1%) cream, and ivermectin (1%) cream.
Isotretinoin at 0.5 to 1 mg/kg/day can be used to treat erythematotelangiectatic rosacea and papulopustular rosacea subtypes that are recalcitrant to other therapies. Tetracyclines show clinical efficacy in the treatment of rosacea, which the researchers mainly attribute to the anti-inflammatory effects of this drug class. The researchers add that doxycycline and minocycline feature increased bioavailability, longer half-life, and low gastrointestinal-related adverse effects compared with first-generation molecules. Macrolides — including azithromycin, clarithromycin, and erythromycin — are effective and safe options, especially in patients who are not good candidates for tetracyclines.
The study authors point to several different laser and light therapy options that have indicated efficacy in the treatment of rosacea. Light-based treatments may be useful for varied vascular manifestations of rosacea, including flushing, erythema, and telangiectasia.
Can proteasome inhibitors effectively treat rosacea? Find out inDermWorld.
DermWorld Insights and Inquiries: “Stepping up” to off-label dosing of biologics
It is an exciting time to be a medical dermatologist, with the ongoing development of numerous safe and effective systemic treatments for several complex medical dermatologic diseases. For example, both the American and British guidelines for the management of psoriasis with biologic therapies describe an expansive array of agents that ease our patients’ disease burden and suffering. But what should a dermatologist do if their patient’s disease does not adequately respond to the FDA-labeled dosing? In the case of psoriasis, should the dermatologist switch to another biologic treatment, but run the risk of cycling through available treatments too quickly for a chronic disease that will likely require indefinite (and possibly lifetime) treatment? Or is it safe to use biologics in an “off-label” fashion in the everyday clinical setting, either at a higher dose, or at a reduced dosing interval, when compared to the FDA-labeled dosing? Keep reading!
Improving itch in prurigo nodularis patients
A study published in theJournal of the European Academy of Dermatology and Venereologyexamined the efficacy of oral nalbuphine in a phase 2 study with an open label 50-week extension. In total, 63 patients with prurigo nodularis were randomized into treatment with the kappa opioid agonist/mu opioid antagonist nalbuphine (81 mg or 162 mg extended release) or placebo.
Of the 50 patients who completed 10 weeks of treatment, there was no difference in the primary endpoint of >30% reduction in itch scores. However, most subjects who continued to 50 weeks of treatment demonstrated healing of skin lesions. The authors conclude that oral treatment with oral nalbuphine 162 mg twice daily provided measurable anti-pruritic efficacy in subjects completing at least 10 weeks of treatment.
Itch experts discuss the latest in understanding and treatment of chronic itch in this month’s DermWorld.
What acne treatments are being recommended on YouTube?
AJAAD research letter analyzed 96 YouTube videos on acne to better understand the quality of recommended therapies. Using the 2016 acne guidelines published in JAAD, the authors categorized the strength of the recommendation as A, B, or C. They also recorded natural home remedies as a separate unrated category.
[Digital marketing for dermatologists: Learn more about how to get started with social media or take your online presence to the next level inDermWorld.]
The authors found that two-thirds of the videos were based on patient/blogger perspectives, 15% featured dermatologists, 8% featured media representatives, 7% featured non-dermatologist medical professionals, 2% featured aestheticians or related cosmetic professionals, and 2% were unidentified. Just over one-third of the videos (34%) contained class A recommendations; 64% contained class B recommendations; 2% contained class C recommendations; and 36.5% contained natural home remedies.
The most recommended therapies included natural home remedies such as toothpaste, aloe vera, and honey, as well as alternative and complementary therapies, with tea tree oil mentioned in many videos. Lifestyle modifications such as reducing glycemic index and dairy consumption were also emphasized. The most frequently referenced active ingredient recommendations included salicylic acid and benzoyl peroxide.
Looking for resources on how to promote your practice?Look no further.
A review of systemic treatments for vitiligo
A literature review published in the International Journal of Dermatologysummarizes systemic treatments for vitiligo and provides evidence-based recommendations for their use. The authors recommend oral corticosteroids as first-line agents, with minocycline used for those whom oral corticosteroids are contraindicated. While the authors note that steroid-sparing agents, including mycophenolate mofetil, have shown promising results, more studies are needed, so they are reserved for patients who can’t take either corticosteroids or minocycline. The authors also state that oral JAK inhibitors together with phototherapy may be more effective than JAK inhibitors alone.
Learn more about expanding indications of the excimer laser for disorders of hypopigmentation inDermWorld Insights and Inquiries.
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