Systematic review of rosacea treatments.
BACKGROUND
Rosacea is a common chronic skin and ocular condition. It is unclear which treatments are most effective. We have conducted a Cochrane review of rosacea therapies. This article is a distillation of that work.


OBJECTIVE
We sought to assess the evidence for the efficacy and safety of rosacea therapies.


METHODS
Multiple databases were systematically searched. Randomized controlled trials in people with moderate to severe rosacea were included. Study selection, assessment of methodologic quality, data extraction, and analysis were carried out by two independent researchers.


RESULTS
In all, 29 studies met inclusion criteria. Topical metronidazole is more effective than placebo (odds ratio 5.96, 95% confidence interval 2.95-12.06). Azelaic acid is more effective than placebo (odds ratio 2.45, 95% confidence interval 1.82-3.28). Firm conclusions could not be drawn about other therapies.


CONCLUSIONS
The quality of the studies was generally poor.


CONCLUSIONS
There is evidence that topical metronidazole and azelaic acid are effective. There is some evidence that oral metronidazole and tetracycline are effective. More well-designed, randomized controlled trials are required to provide better evidence of the efficacy and safety of other rosacea therapies.
van Zuuren
Esther J
EJ
Department of Dermatology B1-Q, Leiden University Medical Center, The Netherlands. E.J.van_Zuuren@lumc.nl
Gupta
Aditya K
AK
Gover
Melissa D
MD
Graber
Mark
M
Hollis
Sally
S
D000279:Administration, Cutaneous; D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001585:Benzoyl Peroxide / Q000008:administration & dosage / Q000627:therapeutic use; D003358:Cosmetics; D003998:Dicarboxylic Acids / Q000008:administration & dosage / Q000627:therapeutic use; D004032:Diet; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D006801:Humans; D008795:Metronidazole / Q000008:administration & dosage / Q000627:therapeutic use; D009853:Omeprazole / Q000008:administration & dosage / Q000627:therapeutic use; D026023:Permethrin / Q000008:administration & dosage / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012107:Research Design / Q000592:standards; D012393:Rosacea / Q000188:drug therapy*; D016037:Single-Blind Method; D013473:Sunscreening Agents / Q000008:administration & dosage / Q000627:therapeutic use; D013754:Tetracyclines / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D003358:Cosmetics; D003998:Dicarboxylic Acids; D013473:Sunscreening Agents; D013754:Tetracyclines; D008795:Metronidazole; D026023:Permethrin; C010038:azelaic acid; D009853:Omeprazole; D001585:Benzoyl Peroxide