SYDNEY, AUSTRALIA – Treatment with topical tretinoin resulted in complete resolution of rosacea symptoms in a significant number of patients, in a small retrospective study presented at the annual meeting of the Australasian College of Dermatologists.
“As an intermediary step between topical antibiotics and oral isotretinoin, we propose that topical tretinoin may be effective in the management and reduction of rosacea symptoms,” Emily Forward, MD, of the University of Sydney, said at the meeting. There has been recent discussion regarding the use of low-dose isotretinoin in the treatment of rosacea, but safety with long-term use is an issue, she noted.
More than 80% of patients had complete or excellent resolution of papules and pustules, with only one patient showing no benefit. Of the patients with erythema as the primary feature of their rosacea, 42% achieved complete resolution, 33% achieved excellent resolution, 17% achieved a good response, and 8% showed no benefit, Dr. Forward reported.
Among patients with telangiectasia, 40% achieved complete resolution, while 37% of those with flushing achieved complete resolution.
Topical tretinoin should be considered among the treatment options for rosacea “as it is effective, well tolerated, and has synergistic benefits in the prevention of photoaging,” Dr. Forward said. The ideal patient candidate would be someone with inflammatory features such as papules, pustules, or erythema, she added.
No patients experienced worsening of their symptoms with treatment, although one patient stopped treatment because of adverse effects. Dr. Forward also stressed that tretinoin is a known teratogen, so it should not be used during pregnancy or breastfeeding, or in patients trying to conceive.
In an interview, Dr. Forward said that she and her associates were surprised at the degree of improvement with topical tretinoin, particularly for erythema symptoms. However, she said it was important to educate patients about how to use topical tretinoin. “You use a pea-sized amount, at night, and in the beginning we advise them to use it every second or third day, and if they tolerate it they can increase the amount,” she said.
No conflicts of interest were declared.