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If your eyes hurt while reading this, just read the bold parts!
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Although the majority of included studies were assessed as being at high or unclear risk of bias, there was some evidence to support the effectiveness of:
1. topical metronidazole,
2. azelaic acid, and
3. doxycycline (40 mg) in the treatment of moderate to severe rosacea, and
4. cyclosporine 0.05% ophthalmic emulsion for ocular rosacea.
Further welldesigned, adequately-powered randomised controlled trials are required.
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Perhaps it is possible to get metronidazole, azelaic acid, and doxycycline in a form that is safe to go in your eyes such as an eye drop?
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The symptoms of ocular rosacea are often mild but can also be severe and debilitating, and although ocular involvement occurs in up to 58% of people with rosacea, only two trials included in this review examined the treatment of ocular rosacea. Although there was insufficient evidence to support the efficacy of topical metronidazole for ocular rosacea, there was some evidence of a consistent improvement in all outcomes that cyclosporine 0.05% ophthalmic emulsion was more effective than artificial tears in the treatment of ocular rosacea.
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CONCLUSION
Evidence of treatment effect could be demonstrated for only a limited number of the interventions studied. These were for interventions with topical metronidazole, azelaic acid, and doxycycline (40 mg) in the treatment of moderate to severe rosacea, and cyclosporine 0.05% ophthalmic emulsion for ocular rosacea.
Erythematotelangiectatic Rosacea:
There is insufficient evidence to support either the effectiveness or lack of effectiveness of interventions for the management of erythematotelangiectatic rosacea. Clearing of the "redness of the face" in patients with rosacea can have a significant impact on their quality of life but the evidence for the efficacy of light-based therapies, which are commonly used for erythematotelangiectatic rosacea, is lacking and further studies addressing the efficacy of these treatment modalities are warranted.
Papulopustular Rosacea:
For papulopustular rosacea, topical metronidazole, azelaic acid, and anti-inflammatory dose doxycycline (40 mg) appear to be effective and safe for short-term use, with similar rates of adverse events as in the placebo groups except for doxycycline 40 mg that showed an increased risk of side effects. There is evidence that 40 mg is at least as effective as 100 mg with evidence of less adverse effects and there is some evidence that tetracycline is effective. No clear evidence is available demonstrating that any one of these treatments, or any combination of treatments, has a particular advantage in terms of higher remission rates and/or fewer adverse effects.
Phymatous Rosacea:
No studies could be included that addressed treatment of phymatous rosacea. Well designed RCTs addressing which is the most effective treatment for phymatous rosacea are therefore still required.
Ocular Rosacea:
For ocular rosacea cyclosporine 0.5% ophthalmic emulsion showed some evidence of benefit over artificial tears. The impact of available treatment on ocular rosacea warrants further examination as up to 58% of patients with rosacea suffers from this subtype.
Final Remarks:
Finally, there is an urgent need for high-quality, well-designed, and rigorously-reported studies of the more widely-used treatments for rosacea like tetracycline, minocycline, azithromycin, isotretinoin, topical retinoids, and light-based therapies. Less direct interventions, such as dietary adjustments, avoidance measures for trigger factors, the use of sunscreens, and patient education are further areas of much-needed research. Outcomes collected in future trials should be primarily based on a standardised scale of the participant's assessment of the treatment efficacy and also have a greater emphasis on changes in quality of life as a result of the interventions.
Standardised and uniform scales should be developed and used for physicians' assessments, and these should reliably reflect global evaluation, lesion counts, and assessment of telangiectasia. Furthermore, to ensure improved clinical decision-making, future research should place a greater emphasis on the management and treatment of rosacea based on the staging pattern of the disease.
http://www.ncbi.nlm.nih.gov/pubmed/21692773
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Although the majority of included studies were assessed as being at high or unclear risk of bias, there was some evidence to support the effectiveness of:
1. topical metronidazole,
2. azelaic acid, and
3. doxycycline (40 mg) in the treatment of moderate to severe rosacea, and
4. cyclosporine 0.05% ophthalmic emulsion for ocular rosacea.
Further welldesigned, adequately-powered randomised controlled trials are required.
--------------------------------------------------------------------------------
Perhaps it is possible to get metronidazole, azelaic acid, and doxycycline in a form that is safe to go in your eyes such as an eye drop?
--------------------------------------------------------------------------------
The symptoms of ocular rosacea are often mild but can also be severe and debilitating, and although ocular involvement occurs in up to 58% of people with rosacea, only two trials included in this review examined the treatment of ocular rosacea. Although there was insufficient evidence to support the efficacy of topical metronidazole for ocular rosacea, there was some evidence of a consistent improvement in all outcomes that cyclosporine 0.05% ophthalmic emulsion was more effective than artificial tears in the treatment of ocular rosacea.
---------------------------------------------------------------------------------
CONCLUSION
Evidence of treatment effect could be demonstrated for only a limited number of the interventions studied. These were for interventions with topical metronidazole, azelaic acid, and doxycycline (40 mg) in the treatment of moderate to severe rosacea, and cyclosporine 0.05% ophthalmic emulsion for ocular rosacea.
Erythematotelangiectatic Rosacea:
There is insufficient evidence to support either the effectiveness or lack of effectiveness of interventions for the management of erythematotelangiectatic rosacea. Clearing of the "redness of the face" in patients with rosacea can have a significant impact on their quality of life but the evidence for the efficacy of light-based therapies, which are commonly used for erythematotelangiectatic rosacea, is lacking and further studies addressing the efficacy of these treatment modalities are warranted.
Papulopustular Rosacea:
For papulopustular rosacea, topical metronidazole, azelaic acid, and anti-inflammatory dose doxycycline (40 mg) appear to be effective and safe for short-term use, with similar rates of adverse events as in the placebo groups except for doxycycline 40 mg that showed an increased risk of side effects. There is evidence that 40 mg is at least as effective as 100 mg with evidence of less adverse effects and there is some evidence that tetracycline is effective. No clear evidence is available demonstrating that any one of these treatments, or any combination of treatments, has a particular advantage in terms of higher remission rates and/or fewer adverse effects.
Phymatous Rosacea:
No studies could be included that addressed treatment of phymatous rosacea. Well designed RCTs addressing which is the most effective treatment for phymatous rosacea are therefore still required.
Ocular Rosacea:
For ocular rosacea cyclosporine 0.5% ophthalmic emulsion showed some evidence of benefit over artificial tears. The impact of available treatment on ocular rosacea warrants further examination as up to 58% of patients with rosacea suffers from this subtype.
Final Remarks:
Finally, there is an urgent need for high-quality, well-designed, and rigorously-reported studies of the more widely-used treatments for rosacea like tetracycline, minocycline, azithromycin, isotretinoin, topical retinoids, and light-based therapies. Less direct interventions, such as dietary adjustments, avoidance measures for trigger factors, the use of sunscreens, and patient education are further areas of much-needed research. Outcomes collected in future trials should be primarily based on a standardised scale of the participant's assessment of the treatment efficacy and also have a greater emphasis on changes in quality of life as a result of the interventions.
Standardised and uniform scales should be developed and used for physicians' assessments, and these should reliably reflect global evaluation, lesion counts, and assessment of telangiectasia. Furthermore, to ensure improved clinical decision-making, future research should place a greater emphasis on the management and treatment of rosacea based on the staging pattern of the disease.
http://www.ncbi.nlm.nih.gov/pubmed/21692773
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