A comparison of topical azelaic acid 20% cream and topical metronidazole 0.75% cream in the treatment of patients with papulopustular rosacea,☆☆,

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Abstract

Background: Although it is important for physicians to have sufficient clinical data on which to base treatment decisions, little comparative data exist regarding newer treatment modalities for rosacea. Objective: The goal of the study was to compare the efficacy and safety of topical azelaic acid 20% cream and topical metronidazole 0.75% cream in the treatment of patients with papulopustular rosacea. Parameters of patient satisfaction to treatment were also assessed. Methods: Forty patients with the clinical manifestation of symmetric facial rosacea were investigated in this single-center, double-blind, randomized, contralateral split-face comparison clinical trial. Results: After 15 weeks of treatment, both azelaic acid and metronidazole induced significant, albeit equal reductions in the number of inflammatory lesions (pustules and papules). A significantly higher physician rating of global improvement was achieved with azelaic acid. Changes in the rosacea signs and symptoms of dryness, burning, telangiectasia, and itching were equal between treatments. A reduction in erythema tended toward significance with azelaic acid at week 15. A trace amount of stinging on application was noted with azelaic acid; however, such discomfort did not appear to concern patients because their overall impression of azelaic acid was superior to that of metronidazole. Conclusion: Azelaic acid 20% cream provides an effective and safe alternative to metro-nidazole 0.75% cream with the added benefit of increased patient satisfaction. (J Am Acad Dermatol 1999;40:961-5.)

Section snippets

PATIENTS AND METHODS

This study was a single-center, randomized, double-blind, contralateral, split-face comparison of topical azelaic acid 20% cream (Allergan, Inc.) and topical metronidazole 0.75% cream (Galderma Canada, Inc.) in patients with papulopustular rosacea. Study medications were randomly assigned to either side of the face (ie, azelaic acid cream on one side of the face and metronidazole cream on the other side) and were applied twice daily for 15 weeks. Study visits occurred at baseline (week 0) and

RESULTS

A total of 40 white patients were enrolled into the study, of which 37 completed 15 weeks of treatment. A summary of patient demographics is provided in Table I.

. Demographics

Empty CellMaleFemale
No.1129
Mean age (y) (range)52.2 (26-75)49.6 (34-69)
Rosacea duration (y)
 < 10.0%0.0%
 1-20.0%6.9%
 3-536.4%24.1%
 6-1018.2%20.7%
 > 1045.4%48.3%
One patient discontinued because of an adverse event not related to treatment (cardiac arrest) and 2 patients discontinued the study for personal reasons (relocated; insufficient

DISCUSSION

This is the first published comparative study of azelaic acid cream and metronidazole cream in patients with rosacea. Results demonstrate that these medications are equally effective in reducing the number of inflammatory lesions and associated signs and symptoms of rosacea. However, the physician rating of global improvement was significantly more favorable for azelaic acid than metronidazole.

Provided that study patients present with symmetric disease, split-face comparative studies offer the

References (10)

  • VS. Nanda

    Common dermatoses

    Am J Obstet Gynecol

    (1995)
  • G. Plewig

    Rosacea

  • PA Bleicher et al.

    Topical metronidazole therapy for rosacea

    Arch Dermatol

    (1987)
  • NJ Lowe et al.

    Flash lamp pumped dye laser for rosacea-associated telangiectasia and erythema

    J Dermatol Surg Oncol

    (1991)
  • GJ Goodman et al.

    Update on lasers in dermatology

    Med J Aust

    (1996)
There are more references available in the full text version of this article.

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Supported by a grant provided by Allergan, Inc.

☆☆

Reprint requests: Stuart Maddin, MD, FRCPC, University of British Columbia, Division of Dermatology, Faculty of Medicine, Skin Care Centre, 835 W 10th Ave, Vancouver, British Columbia, V5Z 4E8, Canada.

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