Cosmeceuticals such as Kinerase (Valeant), niacinamide and a combination of methylsulfonylmethane and silymarin can have a place in treating rosacea, particularly when there is a reason why pharmacological therapies can be used. However, as the number of treatments claiming to help with skin redness grows, physicians shouldwarn patients that just because something can treat redness, that doesn't necessarily mean it can treat rosacea.
"Cosmeceuticals can have a lower side-effect profile, and they really can help to increase the effectiveness of some prescriptions," Dr. Roberts tells Dermatology Times.
Cosmeceuticals with anti-inflammatory properties can offer reduction in redness and skin sensitivity, and inflammatory papules of rosacea to varying degrees.
Among the most well-known cosmeceuticals is Kinerase (Valeant), which includes the ingredient N6-furfuryladenine, a synthetic version of kinetin, a plant hormone reported to help improve the skin barrier function and decrease erythema.
One recent open-label clinical trial of a twice-daily application of kinetin 0.1 percent showed the product to be well-tolerated for people with mild to moderate rosacea. (Clin Exp Dermatol. 2007 Nov;32(6):693-695).
"Kinerase is the cosmeceutical that has probably been in use the longest for rosacea," Dr. Roberts says. "It has shown efficacy in reducing redness in our rosacea patients."
Other products offering some benefit for rosacea symptoms include salicylic acid, a product of willow bark, and a long-time staple for acne treatment. Salicylic acid can specifically help to treat rosacea-related acne, Dr. Roberts says.
"Studies show salicylic acid can help reduce that acne component of rosacea, and products such as Rosaliac and Effaclar (La Roche-Posay) and the Neutrogena OTC Acne line provide that," she says.
A recent study has shown that a combination of methylsulfonylmethane and silymarin, a compound derived from the seeds of the milk thistle plant, can also be an effective treatment for helping rosacea.
The double-blind study of a topical combination of the products showed statistically significant improvement in areas including skin redness, papules, itching, hydration and skin color, and the treatment was said to be particularly effective in the rosacea subtype 1 erythematotelangiectatic phase. (J Cosmet Dermatol. 2008 Mar:7(1):8-14).
Niacinamide (NIA-24) has been promoted to help with the symptoms of rosacea; however, studies have been inconclusive and have shown only some initial exacerbation of erythema.
Nevertheless, there have been a fair amount of anecdotal reports of the product's benefits, and Dr. Roberts noted that she has seen good results with the treatment.
Another cosmeceutical, gluconolactone, a second-generation polyhydroxy acid sold as NeoStrata, has shown investigator-observed improvement of rosacea in European studies when used in combination with oral medications.
Feverfew PFE (parthenolide-free extract), a member of the sunflower family, is sold in over-the-counter rosacea products for its antioxidant and anti-inflammatory properties, and green tea (Replenix, Topix) has been shown to have highly potent antioxidant properties; however, there have been no clinical trials in its effectiveness in treating rosacea.
With consumer demand for natural and organic skincare products greater than ever, there is no shortage of cosmetic-counter skincare therapies claiming to reduce skin redness, but physicians and patients alike should be wary of products that have not been tested specifically for rosacea, Dr. Roberts says.
When considering over-the-counter products or cosmeceuticals to treat their rosacea, patients should be warned that some might, in fact, make their condition worse.
Despite good results, Dr. Roberts says that, with a lack of testing and research behind them, cosmeceuticals should be highly scrutinized before being used to treat rosacea.
"We should carefully examine the claims of cosmeceuticals, expand our scientific knowledge of the mechanisms of action and increase the number of placebo-controlled double-blind studies to rigorously test the science."
Disclosure: Dr. Roberts has consulting relationships with Sanofi-Aventis/Dermik, Bioform, Allergan, OrthoNeutrogena, Steifel Laboratories and L'Oréal/La Roche-Posay, and works as an investigator with Colbar/Johnson & Johnson.