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Topical Vasoconstrictor

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Getting the Red Out: Treating Rosacea with a Topical Vasoconstrictor

Brimonidine tartrate safely reduced redness in patients with erythematotelangiectatic rosacea.

Patients tend to hate the redness of facial erythematotelangiectatic rosacea. The highly selective α2-adrenergic receptor agonist brimonidine tartrate (BT) has potent vasoconstricting effects and might be effective as a topical vasoconstrictor. These investigators performed a two-part, phase II, randomized study to determine the efficacy, safety, and optimal dosing of topical BT gel for erythema of rosacea.

In 122 patients with severe facial rosacea erythema who received a single BT application, BT gel significantly reduced redness in a dose-dependent manner compared with vehicle alone. In a second, more definitive study conducted at 17 sites, 260 patients with moderate-to-severe erythematotelangiectatic rosacea and fewer than three inflammatory papules or pustules applied BT (0.5% or 0.18%) or vehicle daily or twice daily. Significantly better scores on an author-devised and validated scale measuring erythema were achieved with BT 0.5% versus vehicle (P<0.001). The 0.18% cream was also statistically superior to vehicle, but favorable results were less pronounced. Twice-daily dosing did not improve outcomes. No tachyphylaxis, increases in number of lesions, or rebounding occurred in 4 weeks of follow-up. A few patients in the BT and vehicle-alone groups had more erythema at the end of follow-up than at baseline. Recipients generally tolerated the treatments well; one withdrew because of burning sensations. Heart rates and blood pressures remained stable.

Comment: A safe, effective medical treatment for erythematotelangiectatic rosacea represents an unmet dermatological need. In many previous studies of treatments for papulopustular rosacea, redness scores decreased but seldom sufficiently to satisfy either patients or treating physicians. Happily, in this study, topical brimonidine tartrate safely reduced redness in patients with primarily erythematotelangiectatic rosacea. I previously studied this drug in a proof-of-concept, phase I openstudy of patients with facial redness of various causes, and also found that topical BT solution rapidly and regularly reduced redness.

Mark V. Dahl, MD

Published in Journal Watch Dermatology November 23, 2011

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