A New Tool To Fight Facial Redness
By Kyle T. Amber MD
The treatment of erythematotelangiectatic rosacea remains a challenge. While medications such as topical and oral antibiotics can be very helpful for papular (bumpy) rosacea or with pustules, getting rid of the residual redness can be a challenge. Likewise, other medications like Finacea (azelaic acid) or Soolantra (ivermectin) can be effective in treating papulopustular rosacea, but leave much to be desired in the treatment of persistent facial redness. Pulsed dye laser can lead to significant improvement, but can be painful, costly, and short-lived. What if we could just medically target the blood vessels?
The idea of shrinking the blood vessels to reduce redness is not new. Decongestants such as pseudoephedrine rely on blocking the α1 adrenergic receptor, a key receptor in clamping down peripheral blood vessels. Applying this same concept in rosacea, however, has had some road bumps. Mirvaso (brominidine) is a topical therapy that reduces facial redness. Several well-designed studies supported its efficacy . In the trials, no significant rebound flares were seen. In practice, many patients after using this therapy get a rebound, whereby they can get worse rosacea than they had in the first place. While this is most common in patients who use the therapy several days in a row, some patients even using the medication once, such as for a special event, would notice a significant rebound after therapy. Thus, while many patients will improve with this therapy, several have worse rosacea than what they had to begin with.
Rhofade (Oxymetazoline) is a new FDA approved agent that works similarly, but so far does not seem to have the same risk of rebound rosacea. In its clinical studies, 489 patients were treated once daily for 4 weeks. Only 1% of patients had a rebound. A separate long-term study over a year evaluated an additional 440 patients with facial redness, showing that 3% of patients had a rebound .
Because Rhofade is a newly approved therapy, only time will tell as to whether rebound flares become as big an issue as they are for Mirvaso. As of now, it looks like there is a new weapon in our arsenal in the treatment of erythematotelangiectatic rosacea.
1. Fowler J, Jarratt M, Moore A, Meadows K, Pollack A, Steinhoff M, et al. Once-daily topical brimonidine tartrate gel 0.5% is a novel treatment for moderate to severe facial erythema of rosacea: results of two multicentre, randomized and vehicle-controlled studies. Br J Dermatol. 2012;166:633-41.
2. Rhofade [package insert]. Irvine, CA: Allergan (2017).
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