Can we use acne treatments for rosacea?

Some medications used for acne can also be prescribed for rosacea.

Azelaic Acid.

Azelaic acid is a dicarboxylic acid frequently used against acne. It is typically found in creams or gels at concentrations ranging from 10 to 15%. Over recent years, its potential efficacy on rosacea has been studied. Several clinical trials, conducted on patients with rosacea, have shown that the application of a 15% azelaic acid gel could lead to a significant improvement in the number of erythemas and inflammatory lesions.

From a mechanistic perspective, azelaic acid functions by inhibiting the NF-κB pathway, which is involved in the immune response and the release of pro-inflammatory cytokines. This active ingredient thus helps to soothe redness characteristic of rosacea. Furthermore, azelaic acid possesses keratolytic properties, enabling it to accelerate the lysis of comedones. Finally, this molecule is capable of targeting the bacteria C. acnes and S. epidermidis, which are responsible for skin inflammation.

Clindamycin alone or in combination with benzoyl peroxide.

Commonly found in acne creams, the combination of clindamycin and benzoyl peroxide can also be used to reduce inflammatory lesions of papulopustular rosacea. Clindamycin is an antibiotic while benzoyl peroxide is an active ingredient with antibacterial and sebostatic properties.

A study conducted by WILKIN and his team focused on the effectiveness of topical clindamycin on 43 patients suffering from rosacea. The skin inflammatory lesions presented by the patients were examined over a three-week period. At the end of the study, it was shown that the clindamycin treatment helped to reduce redness and dilation of blood vessels in the face, as well as the number of papules and pustules. Furthermore, clindamycin has the advantage of being a treatment generally well tolerated by patients.

Doxycycline.

Doxycycline is an antibiotic belonging to the second-generation tetracycline family. It is administered orally in tablet form and is often dosed at 50 mg or 100 mg. This molecule is indicated in the treatment of severe to moderate inflammatory acne, but also in that of rosacea. Doxycycline has anti-inflammatory properties that result in a reduction in the number of papules and pustules. It also has antimicrobial activity, particularly against C. acnes.

A recent double-blind study was conducted on 51 patients suffering from rosacea. Half of the volunteers were treated with 20 mg of doxycycline, while the other half received a placebo. Those who were given doxycycline showed a significantly greater improvement in facial inflammation and the number of lesions than those in the control group.

Retinoids.

The retinoids are derivatives of vitamin A that can be used topically, such as tretinoin, or orally, like isotretinoin. They possess comedolytic properties and can contribute to the regulation of skin inflammation. Retinoids work by inhibiting the chemotactic and chemokinetic responses of polymorphonuclear leukocytes as well as the metabolism of arachidonic acid by lipo-oxidation, thus helping to reduce redness and inflammatory lesions.

If topical retinoids are prescribed at similar concentrations for treating acne or rosacea, isotretinoin, on the other hand, is administered at lower doses in the case of rosacea: 10 to 20 mg per day, compared to 0.5 to 1 mg/kg for acne. It is generally reserved for severe or recurring forms of rosacea.