Interventions for rosacea based on the phenotype approach: an updated systematic review including GRADE assessments

E J van Zuuren; Z Fedorowicz; J Tan; M M D van der Linden; B W M Arents; B Carter; L Charland

doi:10.1111/bjd.17590

Interventions for rosacea based on the phenotype approach: an updated systematic review including GRADE assessments

Br J Dermatol. 2019 Jul;181(1):65-79. doi: 10.1111/bjd.17590. Epub 2019 Mar 10.

Authors

E J van Zuuren¹, Z Fedorowicz², J Tan³, M M D van der Linden⁴, B W M Arents⁵, B Carter^{6

7}, L Charland⁸

Affiliations

¹ Dermatology Department, Leiden University Medical Centre, Leiden, 2333 ZA, the Netherlands.
² DynaMed Plus, EBSCO Health, 10 Estes Street, Ipswich, MA, 01938, U.S.A.
³ Department of Medicine, University of Western Ontario, London, Canada.
⁴ Department of Dermatology, Amsterdam University Medical Centre, Amsterdam, the Netherlands.
⁵ Skin Patients Netherlands (Huidpatiënten Nederland), Nieuwegein, the Netherlands.
⁶ Biostatistics and Health Informatics, King's College London, London, U.K.
⁷ Institute of Psychiatry, Psychology and Neuroscience, London, U.K.
⁸ Independent Researcher and Consumer Referee, Quebec, Canada.

Abstract

Background: Rosacea is a common chronic facial dermatosis. Classification of rosacea has evolved from subtyping to phenotyping.

Objectives: To update our systematic review on interventions for rosacea.

Methods: We searched CENTRAL, MEDLINE, Embase, LILACS, Science Citation Index and ongoing trials registers (March 2018) for randomized controlled trials. Study selection, data extraction, risk-of-bias assessment and analyses were carried out independently by two authors. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was used to assess certainty of evidence.

Results: We included 152 studies (46 were new), comprising 20 944 participants. Topical interventions included brimonidine, oxymetazoline, metronidazole, azelaic acid, ivermectin and other topical treatments. Systemic interventions included oral antibiotics, combinations with topical treatments or other systemic treatments. Several studies evaluated laser or light-based treatment. We present the most current evidence for rosacea management based on a phenotype-led approach.

Conclusions: For reducing temporarily persistent erythema there was high-certainty evidence for topical brimonidine and moderate certainty for topical oxymetazoline; for erythema and mainly telangiectasia there was low-to-moderate-certainty evidence for laser and intense pulsed light therapy. For reducing papules/pustules there was high-certainty evidence for topical azelaic acid and topical ivermectin; moderate-to-high-certainty evidence for doxycycline 40 mg modified release (MR) and isotretinoin; and moderate-certainty evidence for topical metronidazole, and topical minocycline and oral minocycline being equally effective as doxycycline 40 mg MR. There was low-certainty evidence for tetracycline and low-dose minocycline. For ocular rosacea, there was moderate-certainty evidence that oral omega-3 fatty acids were effective and low-certainty evidence for ciclosporin ophthalmic emulsion and doxycycline.

Publication types

Systematic Review

MeSH terms

Administration, Cutaneous
Administration, Oral
Anti-Bacterial Agents / administration & dosage
Brimonidine Tartrate / administration & dosage
Combined Modality Therapy / methods
Dermatologic Agents / administration & dosage
Dermatology / methods*
Drug Therapy, Combination / methods
Evidence-Based Medicine / methods*
Facial Dermatoses / classification
Facial Dermatoses / diagnosis
Facial Dermatoses / therapy*
Humans
Intense Pulsed Light Therapy / methods
Low-Level Light Therapy / methods
Oxymetazoline / administration & dosage
Randomized Controlled Trials as Topic
Rosacea / classification
Rosacea / diagnosis
Rosacea / therapy*
Severity of Illness Index
Treatment Outcome

Substances

Anti-Bacterial Agents
Dermatologic Agents
Brimonidine Tartrate
Oxymetazoline