The Use of Azelaic Acid 15% Gel, Topical Retinoids, and Photoprotection in the Management of Rosacea and Comorbid Dermatologic Disorders

Rosacea is a common chronic, inflammatory disease of the skin that can significantly affect quality of life. Although the pathophysiology of rosacea remains unclear, most researchers and clinicians agree that it is a photoaggravated disorder and that the signs of rosacea often parallel those of photoaging and photodamage. The cases presented in this article underscore the relationship that may exist between UV light damage and rosacea. Fortunately, there is an array of topical medications that can help manage this photoaggravated disorder. Azelaic acid is a naturally occurring component of grains that has demonstrated efficacy in the treatment of rosacea and acne vulgaris. Although its mechanism of action is unknown, azelaic acid probably has anti-inflammatory and antioxidant effects. It also has been used successfully as monotherapy and in combination with tretinoin to treat dyschromias such as melasma and postinflammatory hyperpigmentation. The topical application of all-trans-retinoic acid has been shown to provide photoprotection and, with prolonged use, to repair UVA- and UVB-mediated skin damage. The unique combination of azelaic acid, topical tretinoin (off label), and a physical sunblock can provide long-term management of rosacea.