Author:
James Q. Del Rosso, DO, Dermatology Residency Director, Valley Hospital Medical Center, Las Vegas, Nevada

Introduction

Several presentations, related to acne vulgaris and rosacea were given at the 66th Annual Meeting of the American Academy of Dermatology, which was held February 1 – 5, 2008 in San Antonio, Texas. The highlights of these presentations are reviewed below.,

Rosacea Medical Management Guidelines

Dr. Hilary Baldwin, President of the American Acne & Rosacea Society (AARS) presented new rosacea medical management guidelines that were developed solely by the leadership of the AARS.¹ The objectives of these guidelines are: (1) to provide an overview of the fundamental disease state of rosacea and quality of life implications, and (2) to line available pharmacologic treatments for rosacea with reference to supporting research and literature. The pharmacologic agents discussed are inclusive of those that are approved by the US Food & Drug Administration (FDA) based on phase III pivotal trials, commonly used agents based on extensive clinical experience, and less commonly used alternatives reported in peer-reviewed literature.

Dr. Baldwin emphasized the importance of the development of these guidelines by a body of dermatologists with extensive interest and knowledge in the area of rosacea. With third party payers increasingly mounting pressure on approval of therapies for common skin disorders such as rosacea, the importance of referencing what is considered to be appropriate therapy as supported by medical literature and clinical experience cannot be overemphasized. Rosacea, a very common centrofacial disorder in adults characterized by diffuse and/or perilesional erythema, flushing, inflammatory lesions and telangiectasias, has been shown to exhibit a negative impact on quality of life. Signs and symptoms of rosacea often include facial dryness, scaling, flushing, stinging, burning and pruritus. Patients affected by rosacea report adverse psychosocial implications such as (need indices from completed surveys). Effective treatment for rosacea has been correlated with marked improvement in quality of life indices.

Dr. Baldwin stressed that patients with rosacea characteristically exhibit sensitive skin; baseline signs and symptoms prior to therapy commonly include dryness, scaling, stinging, burning, and pruritus. Appropriate skin care, including use of a gentle cleanser and moisturizer, and photoprotection, including sunblock/sunscreen use, are important components of daily skin maintenance in rosacea, and are significant adjuncts to pharmacologic therapy.

Medical therapies discussed by Dr. Baldwin included both topical and oral agents. The three major approved topical therapies for rosacea are cleanser and "leave on" formulations of sulfacetamide 10%-sulfur 5% (S/S); metronidazole 0.75% and 1% gel, lotion and cream; and azelaic acid 15% gel. Multiple randomized, vehicle-controlled and comparative studies with S/S, both blinded and open-label, have confirmed efficacy and safety in patients with inflammatory rosacea measured as marked reduction in inflammatory lesions and erythema. Multiple vehicle formulations of S/S are available including cleanser, cream, gel, and topical suspension. Topical metronidazole is approved by the FDA for inflammatory rosacea based on phase III, double-blind, randomized, vehicle-controlled pivotal studies. Multiple blinded, split-face, and open-label vehicle-controlled studies have been completed supporting the efficacy and safety of both topical metronidazole 0.75% and 1% formulations, including gel, cream and lotion. The 1% formulations of metronidazole are approved for use once daily with the 0.75% formulations approved for twice daily application. Azelaic acid 15% gel is approved for treatment of inflammatory lesions and erythema of rosacea based on phase III pivotal studies, with efficacy and safety supported by multiple blinded and vehicle-controlled trials. At a session which provided an update on topical therapies, Dr. James Q. Del Rosso, President-Elect of the AARS, presented data from a recently completed blinded, randomized trial which demonstrated that azelaic acid 15% gel applied once daily or twice daily are therapeutically similar in efficacy in patients with inflammatory rosacea.²