Dermatologists welcome antibiotics, α-adrenergic agonists and more
With no slam-dunk rosacea (ICD-10 code L71) treatments available, dermatologists welcome new therapies including topical ivermectin, said experts at recent meetings. Meanwhile, dermatologists are rethinking some older therapies while awaiting promising new options under development.
Standouts and struggles
No drug is Food and Drug Administration (FDA)-approved for ocular rosacea, said Julie C. Harper, M.D. She is a Birmingham, Ala.-based dermatologist in private practice who is affiliated with the University of Alabama at Birmingham. She is also president-elect of the American Acne & Rosacea Society (AARS). Dr. Harper spoke recently at the Skin Disease Education Foundation (SDEF)'s 12th Annual Women's & Pediatric Dermatology Symposium, Newport Beach, Calif.
Yet estimates are that 50% to 60% of patients with rosacea have ocular rosacea, she said. "That estimate may be a bit high because it comes from the ophthalmology literature. But it's not uncommon for us to see that in clinic."
Dermatologists should do more than merely write these patients prescriptions, said Dr. Harper, although sometimes dermatologists don't know what else to do. Before prescribing drugs, she recommended teaching patients about good skin care – including how to use warm compresses, eyelid massage and artificial tears, all of which can be very helpful.
"We also tend to think that oral medications are more successful in managing ocular rosacea." However, a recent study showed that topical cyclosporine outperformed oral doxycycline (in terms of ocular signs and symptoms, and symptom relief and treatment) in ocular rosacea.1
"I have prescribed both of those medications. The trick is, if somebody also has cutaneous disease, they already potentially need oral doxycycline. So it's still a reasonable place to start in many patients. But for the person who has very difficult disease or cannot take oral doxycycline, it's important to have topical options."
Regarding other antibiotics, Foamix Pharmaceuticals Ltd. is investigating topical minocycline 1% foam in phase 2 trials for rosacea, with early results expected by 2016's end. Many other companies are developing topical minocycline, said Guy F. Webster, M.D., but none have undertaken studies in rosacea. He is a Hockessin, Delaware-based dermatologist and past AARS president. He spoke recently at the Coastal Dermatology Symposium in Monterey, Calif.