observed clinically.11 From a medical therapy perspective, treatment of papulopustular rosacea warrants a combination of an agent directed against papulopustular lesions (ie, topical metronidazole, topical azelaic acid, topical ivermectin, and/or oral sub-antibiotic dose doxycycline) and a topical alpha-agonist directed against persistent non-transient facial erythema (ie, brimonidine, oxymetazoline). Physical devices may be integrated for treatment of telangiectasias and facial erythema. At the present time, although there are agents in development for acne and rosacea, our ability to improve management outcomes will depend on altering and optimizing our approaches to treatment using agents we currently have available. This includes the use of combination regimens and more aggressive management earlier during the course of disease. It will be important for research to increase in the development of newer agents that address novel MOAs, that can be integrated to optimize combination therapy, and that reduce or avoid antibiotic resistance.
James Q. Del Rosso DO FAOCD FAAD
Research Director JDR Dermatology Research, Las Vegas, NV Dermatology and Cutaneous Surgery Thomas Dermatology, Las Vegas, NV
- Del Rosso JQ, Kircik LH. The sequence of in ammation, relevant biomarkers, and the pathogenesis of acne vulgaris: what does recent research show and what does it mean to the clinician? J Drugs Dermatol. 2013;12(8 Suppl):s109-s115.
- Steinhoff M, Schmelz M, Schauber J. Facial erythema of rosacea – aetiology, different pathophysiologies, and treatment options. Acta Venereol. 2016;96:579-86.
- Del Rosso JQ. Future of acne therapy. Presentation at South Beach Symposium (Futures Therapies CME Symposium), Miami Beach, Florida, February 10, 2017.
- Rosen T. Antibiotic resistance: an editorial review with recommendations. J Drugs Dermatol. 2011;10(7):724-733.
- Del Rosso JQ, Webster GF, Roden T, et al. Status report from the Scientific Panel on Antibiotic Use in Dermatology of the American Acne and Rosacea Society: part 1. Antibiotic prescribing patterns, sources of antibiotic exposure, antibiotic consumption and emergence of antibiotic resistance, impact of alterations in antibiotic prescribing, and clinical sequelae of antibiotic use. J Clin Aesthet Dermatol. 2016;9(4):18-24.
- Tan J, Kang S, Leyden J. Prevalence and risk factors of acne scarring among patients consulting dermatologists in the United States. J Drugs Dermatol. 2017;16(2):97-102.
- Eichen eld L, Krakowski AC, Piggot C, et al. Evidence-based recommendations for the diagnosis and treatment of pediatric acne. Pediatrics. 2013;131 Suppl 3:S163-186.
- Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the man- agement of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945-973.
- Nagler AR, Milam EC, Orlow SJ. The use of oral antibiotics before isotretinoin therapy in patients with acne. J Am Acad Dermatol. 2016;74273-279.
- Del Rosso JQ, Gallo RL, Tanghetti E, et al. An evaluation of potential correlations between pathophysiologic mechanisms, clinical manifestations, and management of rosacea. Cutis. 2013;91(3S):1-7.
- Del Rosso JQ, Thiboutot D, Gallo R, et al. Consensus recommendations from the American Acne & Rosacea Society on the management of rosacea, part 5: a guide on the management of rosacea. Cutis. 2014;93(3):134-138