DESTIN, FLA. — Azelaic acid 15% gel is as effective when used once daily as when used twice daily for the treatment of papulopustular rosacea, and the concomitant use of moisturizer appears to reduce the stinging and burning that a small subset of patients experience with treatment, data from recent studies suggest.
In a randomized, double-blind study of 72 patients with at least moderate inflammatory rosacea, once-daily treatment with azelaic acid 15% gel was as effective as twice daily treatment on all measures at 12 weeks, including qualitative and quantitative assessments (J. Drugs Dermatol. 2008;7:541-6), Dr. James Q. Del Rosso said at a meeting sponsored by the Alabama Dermatology Society.
The mean inflammatory lesion count at 12 weeks was reduced from 19.8 at baseline to 6 in the 37 patients in the twice-daily group, and from 18.2 to 6.6 in 35 patients in the once-daily group, he reported.
As long as patients apply treatment appropriately, they can get twice as much duration out of a single tube, and will have outcomes with once-daily application comparable with twice-daily use in terms of lesion count reduction and overall assessment of improvement, said Dr. Del Rosso, a dermatologist in Las Vegas, who was an investigator for the study.
Also, when the treatment is used along with a moisturizer (an important component of rosacea treatment), the incidence and severity of stinging and burning can be reduced, another study suggested.
Preliminary findings from that split-face study by Dr. Del Rosso and his colleagues showed a definite trend toward reduced stinging and burning when patients used moisturizer (Cerave or Cetaphil cream) after the azelaic acid (J. Clin. Aesthet. Dermatol. 2008;1:20-5). It appears that moisturization repairs the moisture barrier and reduces sensitivity to the drug, he said.
As for whether moisturization or treatment should be applied first—in a recent study, Dr. Del Rosso found that regardless of which of three different moisturizers were used (Cerve, Dove, or Cetaphil), azelaic acid penetration was not impaired, whether the moisturizer was applied before or after the azelaic acid 15% gel in a human skin assay test.
In a recent clinical study of patients with acne vulgaris, the efficacy of tazarotene 0.1% cream was not affected by prior application of a ceramide-based moisturizer (Cerave) but tolerability was improved with application of the moisturizer first, he said.
These findings are a good start for helping dermatologists advise rosacea and acne patients about what, when, and how to use their medications and adjunctive skin care products, he said.
Dr. Del Rosso serves as a consultant, speaker, and/or clinical researcher for Intendis, Allergan, Coria Laboratories, Galderma, Medicis, OrthoNeutrogena, Quinnova Pharmaceuticals, Ranbaxy, SkinMedica, Stiefel, Triax Pharmaceuticals, Unilever, and Warner Chilcott.