Update on the Management of Rosacea: A Status Report on the Current Role and New Horizons With Topical Azelaic Acid

December 2014 | Volume 13 | Issue 12 | Supplement Individual Articles | 101 | Copyright © December 2014


James Q. Del Rosso DO FAOCDa and Leon H. Kircik MDb

aLas Vegas Skin and Cancer Clinics/West Dermatology Group, Henderson, NV; Touro University College of Osteopathic Medicine, Henderson, NV
bIcahn School of Medicine at Mount Sinai, New York, NY; Indiana University School of Medicine, Indianapolis, IN;
Physicians Skin Care, PLLC, Louisville, KY

  1. Del Rosso JQ. Advances in understanding and managing rosacea: part 1: connecting the dots between pathophysiological mechanisms and common clinical features of rosacea with emphasis on vascular changes and facial erythema. J Clin Aesthet Dermatol. 2012;5(3):16-25.
  2. Steinhoff M, Schauber J, Leyden JJ. New insights into rosacea pathophysiology: a review of recent findings. J Am Acad Dermatol. 2013;69(6 suppl 1):s15-s26.
  3. Steinhoff M, Buddenkotte J, Aubert J, et al. Clinical, cellular, and molecular aspects in the pathophysiology of rosacea. J Investig Dermatol Symp Proc. 2011;15(1):2-11.
  4. Schwab VD, Sulk M, Seeliger S, et al. Neurovascular and neuroimmune aspects in the pathophysiology of rosacea. J Investig Dermatol Symp Proc. 2011;15(1):53-62.
  5. Yamasaki K, Kanada K, Macleod DT, et al. TLR2 expression is increased in rosacea and stimulates enhanced serine protease production by keratinocytes.J Invest Dermatol. 2011;131(3):688-697.
  6. Yamasaki K, Gallo RL. Rosacea as a disease of cathelicidins and skin innate immunity. J Investig Dermatol Symp Proc. 2011;15(1):12-15.
  7. Yamasaki K, Gallo RL. The molecular pathology of rosacea. J Dermatol Sci. 2009;55(2):77-81.
  8. Two AM, Del Rosso JQ. Kallikrein 5-mediated inflammation in rosacea: clinically relevant correlations with acute and chronic manifestations in rosacea and how individual treatments may provide therapeutic benefit. J Clin Aesthet Dermatol. 2014;7(1):20-25.
  9. Crawford GH, Pelle MT, James WD. Rosacea: I. Etiology, pathogenesis, and subtype classification. J Am Acad Dermatol. 2004;51(3):327-341.
  10. Layton A, Thiboutot D. Emerging therapies in rosacea. J Am Acad Dermatol. 2013;69(6 suppl 1):s57-s65.
  11. Del Rosso JQ. Management of cutaneous rosacea: emphasis on new medical therapies. Expert Opin Pharmacother. 2014;15(14):2029-2038.
  12. Del Rosso JQ. Management of facial erythema of rosacea: what is the role of topical a-adrenergic receptor agonist therapy? J Am Acad Dermatol. 2013;69(6 suppl 1):s44-s56.
  13. Del Rosso JQ, Gallo RL, Kircik L, Thiboutot D, Baldwin HE, Cohen D. Why is rosacea considered to be an inflammatory disorder? The primary role, clinical relevance, and therapeutic correlations of abnormal innate immune response in rosacea-prone skin. J Drugs Dermatol. 2012;11(6):694-700.
  14. Del Rosso JQ, Baldwin H, Webster G; American Acne & Rosacea Society. American Acne & Rosacea Society rosacea medical management guidelines. J Drugs Dermatol. 2008;7(6):531-533.
  15. Thiboutot D, Thieroff-Ekerdt R, Graupe K. Efficacy and safety of azelaic acid (15%) gel as a new treatment for papulopustular rosacea: results from two vehicle-controlled, randomized phase III studies. J Am Acad Dermatol. 2003;48(6):836-845.
  16. Del Rosso JQ, Webster GF, Jackson M, et al. Two randomized phase III clinical trials evaluating anti-inflammatory dose doxycycline (40-mg doxycycline, USP capsules) administered once daily for treatment of rosacea. J Am Acad Dermatol. 2007;56(5):791-802.
  17. McClellan KJ, Noble S. Topical metronidazole: a review of its use in rosacea. Am J Clin Dermatol. 2000;1(3):191-199.
  18. Azelaic acid 15% gel (Finacea®), Full Prescribing Information, Bayer Health-Care Pharmaceuticals Inc, Whippany, New Jersey, 2014.
  19. Rosina P, Zamperetti MR, Giovannini A, et al. Videocapillaroscopic alterations in erythematotelangiectatic rosacea. J Am Acad Dermatol. 2006;54(1):100-104.
  20. Fleischer AB Jr. The evolution of azelaic acid. Cutis. 2006;77(suppl 2):s4-s6.
  21. Draelos ZD. The rationale for advancing the formulation of azelaic acid vehicles. Cutis. 2006;77(suppl 2):s7-s11.
  22. Elewski B, Thiboutot D. A clinical overview of azelaic acid. Cutis. 2006;77(suppl 2):s12-s16.
  23. Liu RH, Smith MK, Basta SA, Farmer ER. Azelaic acid in the treatment of papulopustular rosacea: a systematic review of randomized controlled trials.Arch Dermatol. 2006;142(8):1047-1052.
  24. Del Rosso JQ, Bhatia N. Azelaic acid gel 15% in the management of papulopustular rosacea: a status report on available efficacy data and clinical application. Cutis. 2011;88(2):67-72.
  25. Elewski BE, Fleischer AB Jr, Pariser DM. A comparison of 15% azelaic acid gel and 0.75% metronidazole gel in the topical treatment of papulopustular rosacea: results of a randomized trial. Arch Dermatol. 2003;139(11):1444-1450.
  26. Kennedy Carney C, Cantrell W, Elewski BE. Rosacea: a review of current topical, systemic and light-based therapies. G Ital Dermatol Venereol. 2009;144(6):673-688.
  27. Fleischer A, Suephy C. The face and mind evaluation study: an examination of the efficacy of rosacea treatment using physician ratings and patients’ self-reported quality of life. J Drugs Dermatol. 2005;4(5):585-590.
  28. Thiboutot DM, Fleischer AB, Del Rosso JQ, Rich P. A multicenter study of topical azelaic acid 15% gel in combination with oral doxycycline as initial therapy and azelaic acid 15% gel as maintenance monotherapy. J Drugs Dermatol. 2009;8(7):639-648.
  29. Del Rosso JQ, Bruce S, Jarratt M, Menter A, Staedtler G. Efficacy of topical azelaic acid (AzA) gel 15% plus oral doxycycline 40 mg versus metronidazole gel 1% plus oral doxycycline 40 mg in mild-to-moderate papulopustular rosacea. J Drugs Dermatol. 2010;9(6):607-613.
  30. Bhatia ND, Del Rosso JQ. Optimal management of papulopustular rosacea: rationale for combination therapy. J Drugs Dermatol. 2012;11(7):838-844.
  31. Del Rosso JQ, Baum EW, Draelos ZD, et al. Azelaic acid gel 15%: clinical versatility in the treatment of rosacea. Cutis. 2006;78(suppl 5):s6-s19.
  32. Del Rosso JQ. Medical treatment of rosacea with emphasis on topical therapies. Expert Opin Pharmacother. 2004;5(1):5-13.
  33. Thiboutot DM, Fleischer AB Jr, Del Rosso JQ, Graupe K. Azelaic acid 15% gel once daily versus twice daily in papulopustular rosacea. J Drugs Dermatol. 2008;7(6):541-546.
  34. Draelos ZD. Noxious sensory perceptions in patients with mild to moderate rosacea treated with azelaic acid 15% gel. Cutis. 2004;74(4):257-260.
  35. Del Rosso JQ, Lehman PA, Raney SG. Impact of order of application of moisturizers on percutaneous absorption kinetics: evaluation of sequential application of moisturizer lotions and azelaic acid gel 15% using a human skin model. Cutis. 2009;83(3):119-124.
  36. Azelaic acid 15% gel (Finacea®), NDA 21-470, Approved labeling, Center for Drug Evaluation and Research, US Food and Drug Administration, 12/24/02.
  37. Azelaic acid 15% gel (Finacea®), Drug approval package (NDA 21-470), US Food and Drug Administration.
  38. Azelaic acid 20% cream (Azelex®) [package insert]. Irvine, California: Allergan Inc; 2013.
  39. Dirschka T, Tronnier H, Fölster-Holst R. Epithelial barrier function and atopic diathesis in rosacea and perioral dermatitis. Br J Dermatol. 2004;150(6):1136-1141.
  40. Del Rosso JQ, Baum EW. Comprehensive medical management of rosacea: an interim study report and literature review. J Clin Aesthet Dermatol. 2008;1(1):20-25.
  41. Del Rosso JQ. The use of moisturizers as an integral component of topical therapy for rosacea: clinical results based on the Assessment of Skin Characteristics Study. Cutis. 2009;84(2):72-76.
  42. Draelos ZD. The effect of topical azelaic acid gel 15% in barrier restoration. Poster presentation. Caribbean Dermatology Seminar, Skin Disease Education Foundation, 2014.
  43. 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.
  44. Mayer-da-Silva A, Gollnick H, Detmar M, et al. Effects of azelaic acid on sebaceous gland, sebum excretion rate and keratinization pattern in human skin: an in vivo and in vitro study. Acta Derm Venereol Suppl (Stockh). 1989;143:20-30.
  45. Coda AB, Hata T, Miller J, et al. Cathelicidin, kallikrein 5, and serine protease activity is inhibited during treatment of rosacea with azelaic acid 15% gel. J Am Acad Dermatol. 2013;69(4):570-577.
  46. Kanada KN, Nakatsuji T, Gallo RL. Doxycycline indirectly inhibits proteolytic activation of tryptic kallikrein-related peptidases and activation of cathelicidin. J Invest Dermatol. 2012;132(5):1435-1442.
  47. Draelos ZD, Elewski B, Staedtler G, Havlickova B. Azelaic acid foam 15% in the treatment of papulopustular rosacea: a randomized, double-blind, vehicle-controlled study. Cutis. 2013;92(6):306-317.

AUTHOR CORRESPONDENCE

James Q. Del Rosso DO FAOCD……................jqdelrosso@yahoo.com
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