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Therapeutic Strategies

Erythema in Rosacea

Current treatment of erythema in rosacea

  • This type has traditionally been treated with avoidance of flushing, photoprotection, and surgical strategies including electrosurgery or laser therapies to treat the erythema and telangiectasias.  Laser therapies include pulse-dye laser (PDL), KTP laser, Nd-YAG laser, or intense-pulsed light (IPL).
  • A significant advancement in treatment of rosacea erythema is now commercially available; once-daily application of brimonidine tartrate gel 0.33% (alpha adrenergic receptor agonist, Mirvaso gel) was recently approved as an effective topical treatment for facial redness of rosacea.
  •  Brimonidine has an excellent safety profile based on its long-term use for glaucoma.  It is a highly selective alpha-2-adrenergic receptor agonist with vasoconstrictive properties with onset of action as quickly as 30 minutes, peak efficacy at 4-6 hours, and duration of effect for 12 hours.  In initial studies it was well tolerated and did not exhibit evidence of tachyphylaxis.  Alpha-1-adrenergic agonists such as oxymetazolone may also have similar efficacy.  Comparative studies of topical brimonidine and surgical/ laser therapies have not yet been published.
  •  Oral beta blocker medications may provide an additional alternative treatment for erythema, though not as an FDA approved drug indication.  Carvedilol has been shown to have moderate efficacy for flushing and erythema, and is tolerated even by normotensive individuals at low doses (initial dose 3.25mg TID, with slow dose escalation up to 25mg).