title: Topical Ivermectin 10 mg/g and Oral Doxycycline 40 mg Modified-Release: Current Evidence on the Complementary Use of Anti-Inflammatory Rosacea Treatments.
abstract: Rosacea is a common, chronic inflammatory skin disease that can present with a variety of signs and symptoms. The potentially simultaneous occurrence of different signs and symptoms is due to different underlying inflammatory pathways, emphasizing the need for complementary treatment approaches. Topical ivermectin cream (10 mg/g) and systemic, oral anti-inflammatory doxycycline (40 mg modified-release) are both approved for the treatment of papulopustular rosacea (PPR). Whether or not a combined therapeutic approach may be more beneficial than monotherapy for patients with PPR remains to be tested. Here, we summarize underlying inflammatory pathways implicated in rosacea and clarify the impact of these two agents on selective pathways during inflammation, due to specific characteristics of their individual mechanisms of action (MoA). Based on the complementary MoA of doxycycline modified-release and ivermectin, a scientific rationale for a combined therapy targeting inflammatory lesions in rosacea is given. We propose that topical ivermectin cream is a promising new candidate as first-line treatment to target the inflammatory lesions of rosacea, which can be used in combination with systemic doxycycline modified-release to provide an optimal treatment approach considering all inflammatory pathways involved in PPR. Funding Galderma.
authors.affiliation: Department of Dermatology, UCD Charles Institute of Dermatology, University College Dublin, Dublin, Ireland. martin.steinhoff@ucd.ie.|Department of Dermatology, University of California, San Diego, CA, USA. martin.steinhoff@ucd.ie.|Department of Neurosciences, University of California, Davis, CA, USA. martin.steinhoff@ucd.ie.
authors.forename: Martin
authors.initials: M
authors.lastname: Steinhoff
authors.affiliation: CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France.|Inserm, U1111, Lyon, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Vocanson
authors.affiliation: Galderma International S.A.S., Paris, France.
authors.forename: Johannes J
authors.initials: JJ
authors.lastname: Voegel
authors.affiliation: Galderma International S.A.S., Paris, France.
authors.forename: Feriel
authors.initials: F
authors.lastname: Hacini-Rachinel
authors.affiliation: Galderma International S.A.S., Paris, France.
authors.forename: Gregor
authors.initials: G
authors.lastname: Schäfer
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D000893:Anti-Inflammatory Agents / Q000494:pharmacology; D003692:Delayed-Action Preparations / Q000494:pharmacology; D004318:Doxycycline / Q000494:pharmacology*; D004359:Drug Therapy, Combination / Q000379:methods; D006801:Humans; D007249:Inflammation / Q000188:drug therapy*; D007559:Ivermectin / Q000494:pharmacology*; D012393:Rosacea / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D003692:Delayed-Action Preparations; D007559:Ivermectin; D004318:Doxycycline
keywords: Dermatology; Doxycycline; Inflammation; Ivermectin; Mechanism of action; Therapy