Now on trial: New rosacea medications hold promise for future

November 1, 2008

Several new compounds are currently being tested for safety and efficacy in treating rosacea. These medications may make treatment easier for patients, an expert says.

Key Points

"I'm very excited about several compounds that are under investigation," Joel Schlessinger, M.D., dermatologist and general cosmetic surgeon, Omaha, Neb., tells Dermatology Times.

"These new topical medications will have the potential for better and easier treatments for patients. No treatments so far have been as dramatic as those in trials now," Dr. Schlessinger says.

Although initial trials have been conducted, the product likely will not be available for several years.

Other Food and Drug Administration (FDA) clinical trials are under way as well.

Azelaic acid 15 percent

Dr. Schlessinger says this drug has been used "off-label" for years in rosacea, but the science is now catching up with it, allowing for better assessments of whether it works as well as other drugs on the market.

"We like to use this drug for rosacea patients with pigmentation issues, as it has a modest benefit for those indications," he says. "Additionally, it is quite well tolerated."

Topical cyclosporine

According to Dr. Schlessinger, ocular rosacea is one of the hardest conditions to treat, as there are virtually no FDA-approved treatments for this indication.

"While topical cyclosporine isn't one of the first drugs that come to mind when deciding what to use to treat ocular rosacea, if it is safe and effective, I would certainly consider it for use," Dr. Schlessinger says.

Galderma, which recently purchased CollaGenex Pharmaceuticals, is also investigating several oral formulations for the treatment of rosacea.

"The challenge so far with oral compounds," Dr. Schlessinger says, "has been to find one that minimizes the risks inherent in a predominantly elderly population that desires treatment but has multiple other medications on board with the potential for significant interactions.

"Typically, the biggest challenge in these compounds is to find one that doesn't cause side effects over a longer period of time, while improving the appearance of rosacea. So far, this has proven to be a challenge in the current FDA trials for many of the compounds.

"Additionally, some of the compounds tested have encountered issues with photosensitivity," Dr. Schlessinger says.

Aczone

Another compound that is showing promise in early trials for rosacea is Aczone (dapzone, Allergan), a product previously tested for acne.

"We are hoping that this product will eventually show some utility for rosacea based on its anti-inflammatory characteristics," Dr. Schlessinger says.

"I personally hope that further clinical trials are performed for it on several other indications," he adds.

The quest continues

Until there is a cure, the quest to find new medications to treat rosacea will continue.

"Rosacea is a very difficult disease to treat," Dr. Schlessinger says. "Additionally, we tend to see a lot of people that have a worsening of their rosacea over time, despite topical or oral medications.

"In fact, the overall impact of rosacea is more significant in people in their fifth and sixth decade, but that doesn't mean they don't want to look the best they can," he says.

Raising the bar

Finding new products will be an ongoing process, and the desire for new and better treatment is expected to increase.

"Keep in mind this is a generation of dermatology patients that have been exposed to wonderful treatments that can improve their wrinkles, their acne and so many other dermatologic conditions, so their expectations are higher than the existing generation of patients who had rosacea," Dr. Schlessinger says.

"While lasers are certainly effective for the improvement of signs of rosacea, there is a subset of patients who still expect medications to do the entire job. It would be nice if these were, at the very least, much more effective than what we currently have available. Hopefully, some of these new treatments will fulfill this promise," Dr. Schlessinger says.

"Essentially, the bar has been raised a little bit higher, and companies are responding with other treatments that may be more effective and prove beneficial for these patients as they get older," he adds.

"Now, patients tend to lose interest in treatment of their rosacea because of the lack of efficacy and the large number of treatments they need over time. But as medications become more effective, I think patients will be more willing to continue on with their treatment."

Disclosure: Dr. Schlessinger has long served as an investigator for Galderma, Allergan and CollaGenex Pharmaceuticals.