Improving treatments HELP rosacea sufferers

National report - While rosacea remains incurable for the estimated 14 million people who suffer from the condition, treatment options are evolving to provide dermatologists with a more effective armamentarium in helping to control the condition.

One of the most exciting developments for rosacea treatment is a major shift in the approach to antibiotics, which stands to overcome the hurdle of potential resistances in treating severe cases.

"People are now looking at antibiotics in a new way," says Karyn Grossman, M.D., a dermatologist in private practice in Santa Monica, Calif. "Instead of using them for bacterial reduction, the anti-inflammatory effect of antibiotics in the treatment is becoming more prominent."

Importantly, the dose of the antibiotic is low enough to not actually kill the bacteria, allowing for a more sustained treatment without the risk of developing a resistance. (See related story.)

"This opens up a very attractive regimen that greatly reduces concerns about resistance," says Jonathan Wilkin, M.D., chairman of the National Rosacea Society's medical board and the former chief of the division of dermatology and dermatological drug products for the FDA.

"It takes the dosage down to a level that preserves the anti-inflammatory activities of the product, and at that low dose, you can take care of the papules and pustules, which are the major problems for rosacea sufferers.

"I don't think it eliminates absolutely all possibility for a resistance," he adds. "But it must so greatly reduce the frequency of resistances that I think this will be a very popular alternative."

The treatment will be particularly beneficial for patients with severe rosacea who don't respond to topicals alone, even after an initial phase of antibiotics, he explains.

Topicals

In terms of newer topical treatments that may also help non-responders, a gel form of dapsone, made by Canadian company QLT Inc., and sold as Aczone Gel, 5%, offers promise of providing the same significant improvement seen with oral dapsone, but without the side effects that represented a risk to users.

Aczone has FDA approval for the topical treatment of acne vulgaris; however, there is a caveat - dermatologists are required to screen patients to determine if they are predisposed to hemolytic anemia due to a deficiency of the enzyme G6PD, (glucose 6-phosphate dehydrogenase). Patients found to have the deficiency need to be monitored with regular blood counts.

Since oral dapsone can be highly effective in treating the papules and pustules of rosacea, its topical use is something that could be highly valuable for dermatologists, Dr. Wilkin says.

"I think this will be a worthy alternative to explore, particularly for those patients who do not respond to the other topical medications that are currently available."

Laser and lights

Heavily promoted lasers and light-based therapies continue to gain popularity for rosacea and acne treatment alike.

Studies, mostly smaller in nature, show that techniques including IPL, pulsed-dye lasers, KTP and radiofrequency can offer the chance to treat visible blood vessels without much bruising or discomfort.

"Laser and light therapies often provide some relief for rosacea patients," Dr. Grossman says. "I personally like combining Levulan Kerastick with IPL treatments."

Until a greater body of research comes out, however, laser use for rosacea will likely remain a matter of doctor preference.

"What we're really looking forward to is larger trials done in a blinded fashion or with more numbers of patients so we can get a better idea of the laser and light-based efficacy on rosacea," adds Diane Thiboutot, M.D., professor of dermatology at the Penn State University College of Medicine, Hershey, Pa.