Interventions for rosacea
van Zuuren EJ, Kramer S, Carter B, Graber MA, Fedorowicz Z
Published in Cochrane Database of Systematic Reviews
Methodology
Cochrane systematic review updated to July 2014 across the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE (from 1946), EMBASE (from 1974), Science Citation Index (from 1988) and five trials registers, for randomised controlled trials in moderate to severe rosacea; duplicate independent selection, extraction, risk of bias assessment and analysis across 67 comparisons.
Key Findings
This Cochrane review of rosacea treatments included 106 randomised trials with 13,631 participants, mean age 48.6 years, mostly with papulopustular rosacea. High quality evidence supported topical azelaic acid (participant-assessed risk ratio 1.46, 95% CI 1.30 to 1.63 versus placebo), topical ivermectin (RR 1.78, 95% CI 1.50 to 2.11 and RR 1.92, 95% CI 1.59 to 2.32), brimonidine for erythema (RR about 2.0 to 2.2 at three hours, with no rebound after stopping), doxycycline (RR 1.59, 95% CI 1.02 to 2.47) and low-dose isotretinoin, which was slightly better than doxycycline 50-100 mg (RR 1.23, 95% CI 1.05 to 1.43). Topical metronidazole (RR 1.98, 95% CI 1.29 to 3.02) and oral tetracycline had moderate quality evidence, while minocycline 45 mg, laser and intense pulsed light and ciclosporin eye drops for ocular rosacea rested on low quality evidence. Doxycycline 40 mg was as effective as 100 mg with fewer adverse effects (RR 0.25, 95% CI 0.11 to 0.54), and clindamycin phosphate with tretinoin was not effective.
Conclusions
High-quality evidence supports several topical and oral drugs for rosacea; supplement evidence remains limited.
Limitations
Of 106 trials, 57 were at unclear and 37 at high risk of bias with only 12 at low risk, and 22 provided no usable data; most studies ran only two to three months, quality of life was measured in just 11 trials, and time to response and duration of remission were poorly reported.
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