New treatment appears effective for rosacea

November 17, 2003

CHICAGO - Application of a new formulation of azelaic acid gel to the face reduces the redness and lesions associated with rosacea better than a commonly used treatment (metronidazole gel), according to an article in the November issue of The Archives of Dermatology, one of the JAMA/Archives journals.

Rosacea is a chronic skin condition characterized by red, flaky patches on the nose and cheeks and sometimes accompanied by lesions that appear similar to small pimples. According to the article, rosacea usually fist appears in people between the ages of 30 and 60 years. Rosacea seems to respond well to topical antimicrobial treatments (creams or gels that kill microorganisms like bacteria), although the mechanisms behind this are not well understood, especially because no microorganisms have been identified as causes of rosacea. Azelaic acid and metronidazole are two antimicrobial preparations used to treat acne, and have also been observed to reduce skin conditions associated with rosacea. A new product containing 15 percent azelaic acid has been formulated specifically to treat rosacea.

Boni E. Elewski, M.D., of the University of Alabama at Birmingham, and colleagues conducted a randomized, double-blind study to compare the new 15 percent azelaic acid gel (Finacea; Berlex Laboratories, Inc., Montville, N.J.) with 0.75 percent metronidazole gel (MetroGel; Galderma Laboratories LP, Fort Worth, Tex.) in treating patients with rosacea. The researchers randomly assigned 251 patients (aged 18 years or older) to use either azelaic acid gel (n=124) or metronidazole gel (n=127). The patients applied the gels to the affected areas twice a day for 15 weeks. Participants enrolled in the study between October 29, 2001 and January 31, 2002.

The researchers found that the azelaic acid gel was better than metronidazole gel at reducing the number of lesions associated with rosacea. Fifty-six percent of patients in the azelaic acid gel group experienced a reduction in redness vs. 42 percent of the metronidazole gel group. The researchers also found that the effectiveness of the metronidazole gel seemed to plateau after 8 weeks, while patients in the azelaic acid gel group showed continuous improvement over 15 weeks.

The researchers conclude: "Results showed that azelaic acid gel was consistently superior to metronidazole gel in improving principal signs of rosacea (for example, reducing inflammatory papules and pustules and reducing erythema [redness] intensity). In addition, azelaic acid gel was superior to metronidazole gel in improving or resolving rosacea signs as measured by two distinct investigators' assessments."

"... these results suggest a beneficial effect of azelaic acid during prolonged treatment periods, warranting further investigation of long-term treatment of rosacea with azelaic acid gel," the authors write.
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(Arch Dermatol. 2003;139:1444-1450. Available post-embargo at archdermatol.com)

For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or e-mail mediarelations@jama-archives.org .

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