title: Optimizing the use of topical brimonidine in rosacea management: panel recommendations.
abstract: Rosacea is a chronic inflammatory disease with a complex pathophysiology that manifests with central facial redness with or without papulopustular lesions. Often, patients with rosacea present with a constellation of signs and symptoms; for best results, the treatment plan should take into account all symptoms manifesting in the individual patient. The first available pharmacologic treatment to address the redness associated with rosacea is topical brimonidine. In the United States, brimonidine topical gel 0.33% is indicated for persistent facial erythema of rosacea; approval was based on clinically significant efficacy and good safety data from large-scale clinical trials. Use of brimonidine in routine clinical practice has yielded new insights that elaborate on the findings from clinical trials. For example, real-world use has shown that a percentage of patients (in our experience, approximately 10 to 20%) treated with brimonidine experience a worsening of erythema that has been called "rebound." Our routine use of this agent for >1 year has yielded strategies to set patient expectations, optimize treatment initiation, and minimize potential problems; this article details those strategies. Because we believe that the term "rebound" has been used to describe several physiologically distinct events, we have also proposed more specific terminology for such events.
authors.forename: Emil A
authors.initials: EA
authors.lastname: Tanghetti
authors.forename: J Mark
authors.initials: JM
authors.lastname: Jackson
authors.forename: Kevin Tate
authors.initials: KT
authors.lastname: Belasco
authors.forename: Amanda
authors.initials: A
authors.lastname: Friedrichs
authors.forename: Firas
authors.initials: F
authors.lastname: Hougier
authors.forename: Sandra Marchese
authors.initials: SM
authors.lastname: Johnson
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Kerdel
authors.forename: Dimitry
authors.initials: D
authors.lastname: Palceski
authors.forename: H Chih-Ho
authors.initials: HC
authors.lastname: Hong
authors.forename: Anna
authors.initials: A
authors.lastname: Hinek
authors.forename: Maria Jose Rueda
authors.initials: MJ
authors.lastname: Cadena
mesh_terms: D000279:Administration, Cutaneous; D058647:Adrenergic alpha-2 Receptor Agonists / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D000068438:Brimonidine Tartrate; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005782:Gels; D006801:Humans; D011810:Quinoxalines / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D012393:Rosacea / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D003879:Dermatologic Agents; D005782:Gels; D011810:Quinoxalines; D000068438:Brimonidine Tartrate