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Azelaic acid found effective in a review of acne rosacea trials.

Design: Review of randomized, double-blind intervention trials investigating the effects of topical azelaic acid (AA) on the course of papulopustular rosacea (acne rosacea) in 873 patients taken from five trials.

Study Medication and Dosage: 20% AA cream or 15% gel formulations applied topically for between nine weeks and three months.

Main Outcome Measures: Mean inflammatory lesion counts, erythema severity scores, and telangiectasia severity.

Key Findings: Four of five trials reported decreases in lesion counts and erythema severity, but none reported a reduction in telangiectasia severity. The findings of three of the four trials favoring AA over placebo were statistically significant. For example, in one trial,

subjects given AA had 48% reduction mean erythema severity, versus 38% with placebo (p=0.03) while in another trial, 46% of patients improved with AA versus 28% with placebo (p=0.001). In a separate trial, conventional treatment (topical metronidizole) reduced the inflammatory lesion count by 69% while AA reduced the count by 78%.

Practice Implications: AA is a naturally occurring dicarboxylic acid found in several grains and is available for topical application without prescription. AA is believed to have antimicrobial actions, which may be responsible for its therapeutic effect. Ten years ago, Dr. Alan Gaby reviewed the evidence showing AA to be effective in the treatment of acne and acne rosacea (Nutr Healing 1996; Aug:3,4,11) and since that time, further supportive evidence has appeared. Yet, many health care practitioners continue to be unaware of the effectiveness of this treatment for both conditions. Hopefully the publication of this new review will change that picture.

Liu R, Smith MK, Basta SA, et al. "Azelaic acid in the treatment of papulopustular rosacea." Arch Dermatol, 2006; 142:1047-1052.

By Steve Austin, ND

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Author:Austin, Steve
Publication:Original Internist
Article Type:Brief article
Geographic Code:1USA
Date:Dec 1, 2006
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