Due to the multifactorial pathogenesis of rosacea, the clinical picture of the disease is heterogeneous. Rosacea is a chronic and recurrent inflammatory pathology whose clinical manifestations often change over time and vary in severity, which requires timely correction of treatment. As new data become available, therapies for rosacea should be updated. Discuss at estet-portal.com topical ivermectin, oxymetazoline and combined topical therapy as recommended by American Acne & Rosacea Society.
- Clinical Use of Ivermectin in Rosacea
- The role of α-adrenergic agonists in the treatment of rosacea
- Persistent erythema in rosacea: combination therapy
Clinical Use of Ivermectin in Rosacea
Ivermectin is a derivative of avermectin characterized by antiparasitic and anti-inflammatory activity.
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Increased amount of Demodex folliculorum on the skin of the face is observed in patients with erythematous-telangiectatic or papulopustular forms of rosacea, compared with the skin of healthy people. Oral administration of ivermectin for demodicosis showed good results in terms of skin manifestations.
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According to the results obtained in the course of randomized trials, the use of 1% ivermectin cream is an effective and safe treatment for moderate to severe papulopustular rosacea.
The use of the drug in this form and concentration once a day is appropriate both in monotherapy and in combination with α-adrenergic agonists.
Ivermectin is also well tolerated by patients.
The role of α-adrenergic agonists in the treatment of rosacea
Oxymetazoline 1% Cream is a α-adrenergic agonist approved by FDA for use in therapy persistent erythema of the face in adult rosacea. Applying the cream to the affected part of the face in the morning is recommended to reduce the severity of erythema throughout the day. A noticeable effect of the drug appears within 1-3 hours after application. The duration of the effect is 8-19 hours. Oxymetazoline of this strength and formulation can be used to treat persistent, non-transient erythema
Read also: Modern aspects of diagnosis and treatment of rosacea
Fig.1 Erythematous and erythematous-telangiectatic rosacea
Brimonidine tartrate, which is also an α-adrenergic agonist, at a concentration of 0.5% once a day shows the highest level of effectiveness in relation to severity of erythema.
Brimonidine tartrate 0.5% gel has a high degree of safety, low systemic exposure and no systemic accumulation.At this concentration and form of release, the drug induces a decrease in the severity of erythema already
after 30 minutes, reaching a maximum effect after 3 hours and the duration of the maximum effect of reducing the intensity of erythema for 6 hours after dose once.
Persistent erythema in rosacea: combination therapyAn important point is the optimal integration of
agonists of α-adrenergic receptors, which are used in the treatment regimen for persistent erythema in rosacea, for combination with other drugs.
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For best resultscombination of drugs: 0.33% brimonidine gel once a day in the morning and ivermectin 1% cream once a day in the evening. The duration of this combination therapy option is 12 weeks.
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In patients withpapulo-pastular form rosacea, the use of 1% cream oxymetazoline in combination with metronidazole, azelaic acid, ivermectin or oral doxycycline, positive improvements in the skin manifestations of the disease are observed: a decrease in the severity of the disease persistent erythema.
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The use ofhardware methods for the treatment of rosacea, such as intense pulsed radiation and pulsed dye laser, is also effective in combination with topical drugs for the treatment of telangiectasias and vascular erythema.
Rosacea is a chronic inflammatory dermatosis characterized by periods of remission and exacerbation. Proper skin care and optimal therapy for each individual patient is a vital component of the treatment of rosacea. Current recommendations American Acne & The Rosacea Society management of the disease is evidence-based and can serve as a guide for specialists.
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