Interventions for rosacea based on the phenotype approach: An updated systematic review including GRADE assessments

Abstract

Background

Rosacea is a common chronic facial dermatosis. Classification of rosacea has evolved from subtyping to phenotyping.

Objectives

Updating our systematic review on interventions for rosacea.

Methods

We searched: CENTRAL in The Cochrane Library, MEDLINE, EMBASE, LILACS, Science Citation Index, and ongoing trials registers (March 2018) for randomised controlled trials. Study selection, data extraction, risk of bias assessment and analyses were carried out independently by two authors. GRADE was used to assess certainty of evidence.

Results

We included 152 studies (46 were new), comprising 20,944 participants. Topical interventions included: brimonidine, oxymetazoline, metronidazole, azelaic acid, ivermectin and other topical treatments. Systemic interventions included: oral antibiotics, combinations with topical treatments or other systemic treatments. Several studies evaluated laser or light‐based treatment.

We present the most current evidence for rosacea management based on a phenotype‐led approach.

Conclusions

For reducing temporarily persistent erythema: there was high certainty evidence for topical brimonidine and moderate certainty for topical oxymetazoline; for erythema and mainly telangiectasia: low to moderate certainty evidence for laser and intense pulsed light therapy.

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