Rosacea Therapies May Potentially Alleviate Burning, Stinging in Patients

Jerry Tan, MD

A new investigation suggested that current rosacea therapies have the potential to improve upon burning and stinging symptoms in addition to visible features.

Though the skin condition is widely defined by its visible presentation, symptoms such as burning and stinging are very common. Approximately 60% of patients with rosacea have reported being bothered by physical discomfort, which in turn affects their overall quality of life (QoL).

Previous research has suggested that current rosacea therapies can induce burning or stinging sensations in patients.

However, there is a lack of guidance regarding clinical evidence as well as how these symptoms can be managed. As such, the affect that these symptoms have on the QoL of patients tends to be overlooked in clinical practice.

As such, investigators led by Jerry Tan, MD, from the Department of Medicine at University of Western Ontario, Canada, amassed the most recent evidence regarding burning and stinging in rosacea and explored the need to address these symptoms in the management of rosacea to improve upon patient outrcomes.

Tan and colleagues utilized PubMed to locates any published literature on burning or stinging in patients with all types of rosacea in the past 5 years.

Beyond burning or stinging sensations, inclusion criteria focused on sensitive skin and rosacea, and rosacea and treatment followed by these sensations. Treatments included brimonidine tartrate, oxymetazoline hydrochloride, minocycline, azelaic, ivermectin, metronidazole, doxycycline, and isotretinoin.

This search strategy was later expanded to include products that were currently in development. Investigators also utilized US prescribing information of currently available topical and oral treatment for erythematous rosacea and papulopustular rosacea.

The team observed that in some instances, available rosacea treatments induced burning/stinging in patients.

A recent global study of 300 patients with moderate disease burden found that 42% reported that itching and/or burning was a reason for non-compliance with prescribed treatments. As a result, Tan and colleagues suggested that clinicians should consider the implications of each treatment when deciding on a particular treatment approach.

Additionally, burning/stinging were reported as adverse reactions in the prescribing information of several rosacea treatments including metronidazole 1% gel, minocycline 1.5% foam, isotretinoin 10-40 mg, brimonidine tartrate 0.33% gel, azelaic acid 15% gel, and ivermectin 1% cream.

Conversely, limited data from the study also suggested that some available rosacea treatment could be used to alleviate burning/stinging.

Tan and investigators noted that most of the data were from topical ivermectin monotherapy. However, studies that featured a combination of ivermectin, modified-release doxycycline as well as combination metronidazole and modified-release doxycycline, and encapsulated benzoyl peroxide showed reduction in burning and stinging symptoms from baseline.

Give this data, investigators suggested that updated guidance on rosacea diagnosis classify symptoms such as stinging or burning as either secondary or minor features.

“To improve clinical guidance, further investigation in clinical studies is needed to fill data gaps, improve our understanding of how to reduce the impact of burning, stinging, and other symptoms of rosacea, and to better incorporate consistent assessment of these symptoms,” the team wrote.

The findings were presented at the American Academy of Dermatology (AAD) 2022 Annual Meeting.