title: A comparison of topical azelaic acid 20% cream and topical metronidazole 0.75% cream in the treatment of patients with papulopustular rosacea.
abstract: BACKGROUND
  Although it is important for physicians to have sufficient clinical data on which to base treatment decisions, little comparative data exist regarding newer treatment modalities for rosacea.
  
  
  OBJECTIVE
  The goal of the study was to compare the efficacy and safety of topical azelaic acid 20% cream and topical metronidazole 0.75% cream in the treatment of patients with papulopustular rosacea. Parameters of patient satisfaction to treatment were also assessed.
  
  
  METHODS
  Forty patients with the clinical manifestation of symmetric facial rosacea were investigated in this single-center, double-blind, randomized, contralateral split-face comparison clinical trial.
  
  
  RESULTS
  After 15 weeks of treatment, both azelaic acid and metronidazole induced significant, albeit equal reductions in the number of inflammatory lesions (pustules and papules). A significantly higher physician rating of global improvement was achieved with azelaic acid. Changes in the rosacea signs and symptoms of dryness, burning, telangiectasia, and itching were equal between treatments. A reduction in erythema tended toward significance with azelaic acid at week 15. A trace amount of stinging on application was noted with azelaic acid; however, such discomfort did not appear to concern patients because their overall impression of azelaic acid was superior to that of metronidazole.
  
  
  CONCLUSIONS
  Azelaic acid 20% cream provides an effective and safe alternative to metronidazole 0.75% cream with the added benefit of increased patient satisfaction.
authors.affiliation: Division of Dermatology, University of British Columbia, Vancouver, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Maddin
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D003879:Dermatologic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003998:Dicarboxylic Acids / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D006801:Humans; D008795:Metronidazole / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D009824:Ointments; D017060:Patient Satisfaction; D012393:Rosacea / Q000188:drug therapy* / Q000473:pathology
chemical_list: D003879:Dermatologic Agents; D003998:Dicarboxylic Acids; D009824:Ointments; D008795:Metronidazole; C010038:azelaic acid