QUIZ RECAP: Test Your Knowledge of Rosacea Treatment Modalities and the Therapeutic Landscape

This week we asked the question: How much do you know about rosacea treatment modalities and the therapeutic landscape?

Haven't taken our quiz yet? Pause before reading below and follow this link to complete it: here.

Below, we recap our third quiz and the correct answers to each question.

Question 1: Which of the following is a first-line topical treatment for papulopustular rosacea?

Response options: Metronidazole; Azelaic acid; Clindamycin; Benzoyl peroxide

Correct response option: Metronidazole

Topical metronidazole is a frequently employed first-line treatment for rosacea, alongside options like topical azelaic acid, sulfacetamide products, and topical acne medications. Both topical and oral antibiotics are highly effective, often used in combination initially, with the possibility of transitioning to maintenance therapy with topical agents alone. However, in cases with ocular involvement, ongoing oral therapy is crucial. For systemic antibiotic use, evidence supports newer regimens like 20-50 mg q12h of doxycycline being as effective as older regimens like 100 mg of doxycycline.¹

Question 2: Which class of medications is NOT recommended for the treatment of rosacea due to potential exacerbation of symptoms?

Response options: Topical corticosteroids; Topical retinoids; Oral tetracyclines; Oral isotretinoin

Correct response option: Topical corticosteroids

Topical steroids can be beneficial for managing short-term exacerbations of lid disease and inflammatory keratitis in patients with ocular rosacea, for example. However, their use should be approached cautiously and discontinued promptly to mitigate the risk of corneal melting. Additionally, caution is warranted as topical steroids may exacerbate rosacea and should be avoided when feasible.²

Question 3: What is the primary mechanism of action of brimonidine gel in the treatment of erythematotelangiectatic rosacea?

Response options: Antibacterial activity; Vasoconstriction; Anti-inflammatory effects; Keratolytic action

Correct response option: Vasoconstriction

Erythema in rosacea is believed to stem from dysregulated cutaneous vasomotor responses, causing abnormal dilation of facial blood vessels upon different triggers. Research indicates the role of adrenergic receptors in this neurovascular pathway. Brimonidine, a relatively selective alpha-2 adrenergic agonist, acts topically to constrict dilated facial blood vessels, potentially reducing the redness associated with rosacea.³

Question 4: Which oral medication is commonly used as a second-line therapy for moderate to severe rosacea, particularly in cases with ocular involvement?

Response options: Doxycycline; Metronidazole; Minocycline; Azithromycin

Correct response option: Minocycline

Minocycline, a tetracycline-class antibiotic, is commonly employed as a second-line therapy for moderate to severe rosacea, particularly in cases with ocular involvement. It exerts its therapeutic effects through its anti-inflammatory and antimicrobial properties. By inhibiting the production of pro-inflammatory cytokines and chemokines, minocycline helps alleviate the inflammatory component of rosacea, reducing papules, pustules, and erythema. Moreover, its ability to suppress matrix metalloproteinases contributes to the mitigation of tissue damage associated with chronic inflammation.¹

Question 5: Which of the following therapies has been shown to effectively target both the inflammatory lesions and persistent facial erythema associated with rosacea?

Response options: Oral metronidazole; Oral azelaic acid; Combination therapy with oral antibiotics and topical metronidazole; Oral ivermectin

Correct response option: Oral ivermectin

The FDA approved ivermectin 1% cream for treating rosacea lesions based on positive outcomes from 2 randomized, controlled, double-blind trials. Participants with moderate-to-severe papulopustular rosacea experienced significant reductions in lesions compared to control cream users. Unlike some rosacea creams that may require up to a month for noticeable effects, ivermectin cream demonstrated results within approximately 2 weeks of use.⁴

References

1. Banasikowska AK. Rosacea medication. Medscape. June 3, 2021. Accessed April 25, 2024. https://emedicine.medscape.com/article/1071429-medication#:~:text=Topical%20metronidazole%20is%20commonly%20used,medications%20are%20also%20commonly%20used
2. Dudee J. Ocular rosacea treatment & management. Medscape. March 13, 2024. Accessed April 25, 2024. https://emedicine.medscape.com/article/1197341-treatment
3. Ranaweera A. Brimonidine. DermNet. 2013. Accessed April 25, 2024. https://dermnetnz.org/topics/brimonidine
4. Healthline. What to know about ivermectin for rosacea. Healthline. Accessed April 25, 2024. https://www.healthline.com/health/rosacea/ivermectin-for-rosacea