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10px; color: #6f6f6f;" align="center"> We respect your privacy and do not share information with any third party. </div> </td> </tr> </table> </td></tr> <tr><td style="background-color:#a1cade;"></td><td style="height:2px;background-color:#a1cade;"><img src="images_v2/spacer.gif" width=1 height=2 border=0></td></tr> </table> </div> <div align="center" class="middleColTitle">  <span> Rosacea Alert:<a name="Top"></a> <br> Prescription Medications that may be Harmful to Rosacea Sufferers<br /><br /> </span>  </div>  <h2 style="margin-top: 0; margin-bottom: 0;"><b>Topics Discussed Below</b> <br> </h2> <hr width="30%" align="left"> <ul class="bullet" style="margin-bottom: 0;"> <li> Introduction<br> <li> Topical retinoids (tretinoin) <br> <li> Caution on other topical retinoids and retinoid-like compounds<br> <li> Azelaic acid <br> <li> Benzoyl peroxide (prescription-based cleansers and creams)<br> <li> References </ul> <hr width="30%" align="left"> <h2></h2> <p style="margin-bottom: 0;"> </p> <h2 style="margin-top: 0; margin-bottom: 0;"><br> </h2> <h2 style="margin-top: 0;">I. Introduction </h2> <p style="margin-top: 0;">Many anti-acne products are known to worsen rosacea symptoms. Medical experts strongly urge rosacea sufferers to stop using these products. There are several classes of topical prescription medications that rosacea sufferers should not use because the risks far out way their benefits.<br> <br> </p> <h2 style="margin-bottom: 0;"> </h2> <h2 style="margin-top: 0;">II. Topical Retinoids (Tretinoin)</h2> <p style="margin-top: 0;">Topical retinoids such as retinoic acid and Vitamin A derivatives are used for the treatment of acne. Many general dermatologists also use topical retinoids to treat rosacea papules and pustules. There is mounting evidence indicating that topical retinoids such as tretinoin should not be used for treating rosacea papules or pustules because they make the underlying vascular disease worse. In a recent medical review, "<i>Rosacea: Pathophysiology and Treatment"</i>, Dr. Jonathan Wilkin discusses numerous reasons why rosacea patients should not use topical retinoids such as tretinoin: (114) </p> <ul> <li> He states, "<i>Tretinoin may provoke severe erythema in patients with rosacea</i>." <br> <br> <li> He further cautions that with tretinoin therapy, "<i>Flushing reactions will have a more intense redness, and there will be an enhancement of the inflammatory process.</i>" <br> <br> <li> Dr. Wilkin stresses, "<i>Irritation from the tretinoin may directly exacerbate the underlying inflammatory reaction.</i>" <br> <br> <li> He also warns, "<i>Tretinoin may cause angiogenesis in the rosacea distribution. The tretinoin-induced erythema may mask the worsening angiogenesis and telangiectasia. I have seen several patients who have bright red faces during treatment with topical tretinoin.</i>" <br> <br> <li> He ends his discussion on tretinoin by stating, <i>"Since rosacea appears to be in its most fundamental elements a vascular disorder, it would be wise to first do <u>no harm</u></i>." </ul> <p></p> <h2 style="margin-bottom: 0;"><br> </h2> <h2 style="margin-top: 0;">III. Caution on Other Topical Retinoids and Retinoid-Like Compounds</h2> <p>Due to their irritant qualities, extreme caution must be given to all topical forms of retinoic acid and vitamin A derivatives. Newer formulations have been developed to lessen the potential for irritation; however, these are still too harsh for many rosacea sufferers. Below are a few quotes on the irritant qualities of these newer formulations:</p> <ul> <li> <b>Retin-A Micro™</b>(tretinoin gel, Ortho Pharma-ceutical Corporation): Although this newer gel was designed to be less irritating, Retin-A Micro™ is still irritating to sensitive skin. <i>The Physicians' Desk Reference (2000)</i> warns, "<i>The skin of certain individuals may become excessively dry, red, swollen, or blistered,</i>" and that, "<i>A transitory feeling of warmth or slight stinging may be noted on application</i>". Additionally, it is warned that, "<i>Weather extremes, such as wind or cold, may be irritating to patients being treated with tretinoin</i>". <br> <br> <li> <b>Avita™ </b>(tretinoin gel, DPT Laboratories): The <i>Physicians' Desk Reference</i> (2000) warns that, "<i>The skin of certain individuals may become excessively red, edematous, blistered, or crusted</i>", and that, "<i>Application may cause a transient feeling of warmth or slight stinging</i>". Additionally, it is warned, "<i>Some patients also notice that their skin begins to take on a blush</i>". <br> <br> <li> <b>Differin™</b> (adapalene gel, Galderma Labor-atories, Inc.): The <i>Physicians' Desk Reference</i> (2000) warns that during treatment with this retinoid-like gel, "<i>Some adverse effects such as erythema, scaling, dryness, pruritus, and burning will occur in 10-40% of patients</i>", and that, "<i>Weather extremes, such as wind or cold, may be irritating to patients under treatment with adapalene</i>". </ul> <p></p> <h2 style="margin-bottom: 0;"><br> </h2> <h2 style="margin-top: 0;">IV. Azelaic Acid</h2> <p style="margin-top: 0;">Azelaic acid is a dietary substance derived from whole grain cereals that can be used topically for the treatment of acne. Although a few studies demonstrate that azelaic acid is effective in the treatment of rosacea papules and pustules, there is evidence indicating that this treatment is very irritating to rosacea skin. In a recent medical study investigators found that topical azelaic acid caused adverse skin reactions in<u> 40% of the rosacea patients</u> (30 out of 76 patients). (137) These reactions included, "<i>Burning, skin irritation, stinging, itching, facial edema, and scaling.</i>" Furthermore, before the actual study began, 5 patients dropped out because azelaic acid caused one or more of the following skin reactions: <i>"Burning, erythema, skin irritation, and contact dermatitis.</i>" As discussed earlier in this chapter, rosacea experts stress that any topical product that causes adverse skin reactions should be avoided.</p> <h2><br> </h2> <h2> V. Benzoyl Peroxide (Prescription cleansers or creams)</h2> <p style="margin-top: 0;">Benzoyl peroxide is a popular medication that is used for acne blemishes. Rosacea experts caution that benzoyl peroxide usually worsens rosacea because it is very irritating and drying to sensitive facial skin. (130, 136) In a recent rosacea review article, "<i>Recognizing Rosacea</i>", Dr. Millikan from the Department of Dermatology, Tulane University Medical School, indicates that benzoyl peroxide should never be used on rosacea skin. (136) In fact, Dr. Millikan indicates that benzoyl peroxide can actually induce rosacea in some patients. In cleanser or cream form, benzoyl peroxide should be avoided in most rosacea patients.</p> <p></p> <h2><br> </h2> <h2>VI. References</h2> <blockquote style="margin-bottom: 0;"> <p>110. National Rosacea Society. "Rosacea Review". Summer. 1996. <i>Drake,L</i>.<br> <br> 111. Wilkin, J.K. Rosacea. <i>Int J Dermatol </i>22: 393-400, 1983.<br> <br> 112. Gifford-Jones. "That rosy blush may be bad". <i>Inside Health Column</i>, 1998.<br> <br> 113. Wilkin, J.K. "Recognizing and managing rosacea". <i>Drug Therapy</i> 41-45, 1993.<br> <br> 114. Wilkin, J.K. Rosacea. Pathophysiology and treatment. <i>Arch Dermatol</i> 130: 359-362, 1994.<br> <br> 115. De Kort, W.J. and A.C. De Groot. Clindamycin allergy presenting as rosacea. <i>Contact Dermatitis</i> 20: 72-73, 1989.<br> <br> 116. National Rosacea Society. "Rosacea Review". Spring. 1997. <i>Drake,L.</i><br> <br> 117. Plewig, G. and A.M. Kligman. Rosacea. In: <i>Acne and Rosacea</i>, edited by G. Plewig and A.M. Kligman. Berlin: Springer-Verlag, 1993, p. 433-475.<br> <br> 118. National Rosacea Society. "Rosacea Review". In: edited by J.K. Wilkin. 1994. <br> <br> 119. National Rosacea Society. "Rosacea Review". Fall. 1996. Drake,L.<br> <br> 120. Prins, M., O.Q. Swinkels, E.G. Kolkman, E.W. Wuis, Y.A. Hekster, and d. van, V. Skin irritation by dithranol cream. A blind study to assess the role of the cream formulation. <i>Acta Derm Venereol</i> 78: 262-265, 1998.<br> <br> 121. De Groot, A.C., J.W. Weyland, and J.P. Nater. "Toxic and irritant contact dermatitis". In: <i>Unwanted effects of cosmetics and drugs used in dermatology</i>, edited by A.C.<br> <br> 131. Ale, S.I., J.P. Laugier, and H.I. Maibach. Differential irritant skin responses to tandem application of topical retinoic acid and sodium lauryl sulphate: II. Effect of time between first and second exposure. <i>Br J Dermatol </i>137: 226-233, 1997.<br> <br> 132. Webster, G.F. Acne and rosacea. <i>Med Clin North Am</i> 82: 1145-54, 1998.<br> <br> 133. Schaller, M., R. Steinle, and H.C. Korting. Light and electron microscopic findings in human epidermis reconstructed in vitro upon topical application of liposomal tretinoin. <i>Acta Derm Venereol</i> 77: 122-126, 1997.<br> <br> 134. Matsuoka, L.Y. "Acne and related disorders". <i>Clin Plast Surg</i> 20: 35-41, 1993.<br> <br> 135. Landow, K. "Dispelling myths about acne". <i>Postgrad Med</i> 102: 94-4, 110, 1997.<br> <br> 136. Millikan, L. Recognizing rosacea. <i>Postgrad Med</i> 105: 149-8, 1999.<br> <br> 137. Bjerke, J.R., O. Fyrand, and K. Graupe. 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