Clindamycin Phosphate 1.2% and Tretinoin 0.025% Gel for Rosacea: Summary of a Placebo-Controlled, Double-Blind Trial
Rosacea is a common, chronic, and poorly understood dermatological condition characterized by an in"ammatory component composed of papules and pustules and a vascular component composed of "ushing and erythema. Current treatment options include topical, systemic, and light-based methods, each of which focuses on either the in"ammatory or the vascular component. Retinoids are not routinely indicated as treatment because of the common conception that they would be too in"ammatory for the sensitive rosacea patient. However, photodamage may play a role in rosacea and tretinoin is well-known to repair photodamage. Thirty rosacea subjects were enrolled to assess their response to the use of clindamycin phosphate 1.2% and tretinoin 0.025% gel (ZIANA; Medicis Pharmaceutical Corporation, Scottsdale, AZ) for a period of 12 weeks. The results showed a dramatic decrease in pustules and papules without any signi!cant in"ammation or overall intolerance. No improvement in facial redness was achieved. Based on our results, more investigation of topical retinoids for rosacea treatment is prudent. J Drugs Dermatol. 2012;11(12):1410-1414.
Article: [Topical therapy of rosacea.][Show abstract] [Hide abstract]
ABSTRACT: Metronidazole and azelaic acid are the only topical medications approved for rosacea. All other topical treatments for rosacea and its special forms are used off-label. Topical steroids are not indicated in rosacea, because of their side effects (induction of steroid rosacea, high risk of facial skin atrophy, and high risk of rebound after cessation of therapy). Topical as well as systemic steroids are allowed only as initial and short term therapy for acute forms of rosacea (e.g. rosacea fulminans). Papular and pustular rosacea is the major indication for topical therapy. Sebaceous gland and connective tissue hyperplasia in glandular-hypertrophic rosacea as well as erythema in erythematous rosacea do not respond well to topical measures. A new active substance, the alpha-2-adrenoreceptor agonist brimonidine, will be approved soon for the topical treatment of erythema in rosacea. All severe forms of rosacea should initially be treated with a combination of topical and systemic agents. After improvement of the clinical symptoms, topical treatment alone is usually adequate to maintain the control.
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ABSTRACT: The purpose of this study was to develop tretinoin-loaded phospholipid vesicles, namely conventional liposomes, hexosomes, glycerosomes and ethosomes, and to investigate their efficacy on croton oil induced rosacea. Vesicles were prepared with soy phospholipid, sodium deoxycholate and tretinoin; 1,2-hexanediol, glycerol and ethanol were added to obtain hexosomes, glycerosomes and ethosomes, respectively. The prepared formulations were characterized in terms of size distribution, morphology, zeta potential and entrapment efficiency. All vesicles were spherical in shape with a mean diameter ranging between 60 and 132 nm and a fairly narrow distribution (0.23–0.29), negative zeta potential values (from −19 to −29 mV) and entrapment efficiency between 32 and 63%. Furthermore, vesicles were evaluated for an in vitro model of dermal delivery, and their mode of action was studied by performing confocal laser scanning microscopy (CLSM) and attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR) analyses. In addition, in vivo skin penetration was also investigated. The results of in vitro and in vivo studies showed that vesicular formulations, especially hexosomes, promoted the drug deposition into the skin stratums and reduced the permeation into the blood. Finally, administration of vesicular tretinoin on croton oil-induced skin resulted in marked attenuation of oedema and inflammatory cells, especially using hexosomes. The proposed approach based on tretinoin vesicular formulations may be of value in the treatment of rosacea.
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ABSTRACT: Although rosacea's impact on physical health is limited, it has profound effects on a person's psychological well-being. Therefore, treating rosacea can greatly affect a person's quality of life. Patient education regarding trigger avoidance and skin care techniques such as moisturizing and sun protection are important non-pharmacologic first steps in treating rosacea. Pharmacologic interventions range from topical to systemic medications, with the ideal medication choice dependent on the symptoms and severity of each individual patient. Despite this variety of therapeutic options, none of these therapies are completely curative, and therefore further research into the pathophysiology of rosacea is required in order to create more targeted and efficacious treatment options. Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.
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