Little data exists on the simultaneous treatment of different features of rosacea. Individually, ivermectin 1% (IVM) cream (Soolantra) and brimonidine (BR) 0.33% gel (Mirvaso) have demonstrated efficacy on inflammatory lesions and persistent erythema, respectively. A recent study evaluated the efficacy, safety, patient satisfaction, and optimal timing of administration of ivermectin 1% associated with brimonidine (IVM+BR) vs their vehicles in rosacea (Investigator’s Global Assessment [IGA] ≥3).
The multicenter, randomized, double-blind study included patients with rosacea characterized by moderate to severe persistent erythema and inflammatory lesions. The active treatment group included the IVM+BR/12 weeks subgroup (once-daily BR and once-daily IVM for 12 weeks), and the IVM+BR/8 weeks subgroup (once-daily BR vehicle for 4 weeks followed by once-daily BR for the remaining 8 weeks and once-daily IVM for 12 weeks). The vehicle group received once-daily BR vehicle and once-daily IVM vehicle for 12 weeks.
The association showed superior efficacy (IGA success [clear/almost clear]) for erythema and inflammatory lesions in the total active group (combined active subgroups) compared with vehicle (55.8% vs 36.8%; P=.007) at week 12. The success rate increased from 32.7% to 61.2% at hour 0 and hour 3, respectively, in the IVM+BR/12 weeks subgroup, and from 28.3% to 50% in the IVM+BR/8 weeks subgroup. Reductions in erythema and inflammatory lesion counts confirmed the additive effect of BR to IVM treatment. The patients reported greater improvement in the active subgroups than in the vehicle group, and similar rates for facial appearance satisfaction after the first 4 weeks of treatment in both active subgroups. All groups showed similar tolerability profiles.
“Concomitant administration of IVM cream with BR gel demonstrated good efficacy and safety, endorsing the comprehensive approach to this complex disease,” according to the researchers. “Early introduction of BR, along with a complete daily skin care regimen may accelerate treatment success without impairing tolerability,” they concluded.
Gold LS, Papp K, Lynde C, et al. Treatment of rosacea with concomitant use of topical ivermectin 1% cream and brimonidine 0.33% gel: A randomized, vehicle-controlled study. J Drugs Dermatol. 2017;16(9):909-916.
Chemical Peels in Men Increasing in Popularity
The study included a review of the English PubMed/MEDLINE literature and specialty texts in cosmetic dermatology, oculoplastic, and facial aesthetic surgery regarding sex-specific use of chemical peels in men. Results showed conditions treated successfully with chemical peels in men include acne vulgaris, acne scarring, rosacea, keratosis pilaris, melasma, actinic keratosis, photodamage, resurfacing of surgical reconstruction scars, and periorbital rejuvenation. Chemical peels are commonly combined with other nonsurgical cosmetic procedures to optimize results. Men may require a greater number of treatments or higher concentration of peeling agent due to increased sebaceous quality of skin and hair follicle density, the researchers noted.
Chemical peels are a cost-effective and reliable treatment for a variety of aesthetic and medical skin conditions. Given the increasing demand for noninvasive cosmetic procedures among men, dermatologists should be versed in chemical peel applications and techniques to address the concerns of male patients.
Reserva J, Champlain A, Soon SL, Tung R. Chemical peels: indications and special considerations for the male patient [published online September 4, 2017]. Dermatol Surg. doi:10.1097/DSS.0000000000001281