• Oxymetazoline and brimonidine: These two alpha-adrenergic receptor agonists are under investigation for their ability to decrease erythema. Both cause a transient vasoconstriction. Two studies of patients with moderate or severe erythema of rosacea found that a topical brimonidine gel formulation significantly decreased erythema for up to 12 hours after application, compared with a vehicle gel (J Drugs Dermatol. 2013 Jun 1;12[6]:650-6). However, there have been several case reports of severe rebound, with redness not only returning, but returning at a more severe grade (J Am Acad Dermatol. 2014 Feb;70[2]:e37-8).
• Isotretinoin: New investigations are looking at topical retinoids for rosacea. They do appear effective – but not only for the reason they work in acne. While they decrease the size of sebaceous glands and the amount of sebum produced, they seem to exert their benefit through an anti-inflammatory pathway, as well. Isotretinoin significantly decreases toll-like receptor-2 expression on monocytes.
Isotretinoin has been shown to be more effective than doxycycline in clearing skin (J Dtsch Dermatol Ges. 2010 Jul;8[7]:505-15) but has also seemed helpful in preventing and slowing phyma development and improving ocular disease.
Both Dr. Cohen and Dr. Baldwin disclosed relationships with multiple pharmaceutical companies.