Rosacea is a chronic skin diseases marked by persistent facial erythema, easy flushing, and the development of telangiectasia. Over time papules and pustules may appear as well. Several topical and systemic medications are used to treat rosacea, but these primarily address the inflammatory lesion component. Treatments for persistent facial erythema are limited, usually requiring pulsed-due laser treatment.

However, there are two topical medications (Mirvaso and Rho-fade) that can constrict facial blood vessels, resulting in a temporary improvement in facial erythema.

Rho-fade is an alpha(1a)-adrenoceptor agonist that causes vasoconstriction in the skin. In a pooled efficacy analysis of two phase 3 clinical trials, patients with moderate to severe persistent erythema received either 1% oxymetazoline cream (Rho-fade) or vehicle cream daily for 29 days. Although oxymetazoline was more efficacious that  vehicle in reducing facial erythema, the results are short lived. The proportion of patients achieving at least a 2 grade decrease in the Clinical Erythema Assessment or Subject-Self Assessment scale at 3 hours post-application on day 29 was 41.7% and 22.1%, respectively, versus 23.7% and 13.4% for vehicle. At 12 hours post-dose, the rate was 27.1% and 24.3%, respectively, versus 19.4% and 13.7%.

No clinically meaningful differences in  adverse events were noted between the two groups, but adverse events were still noted at a high level. The comparison is with vehicle not with no treatment. Approximately 25% of patients saw a 1 grade or more worsening in disease index from baseline. Pruritus (19.3%), stinging/burning (18.4%), dryness (25.6%) and scaling (20.4%) were observed in the treatment group, with similar rates in the vehicle group. Importantly, the rate of rebound was low: 1.7% in the treatment group versus 0.6% in the vehicle group.

Overall, the topical medication Rho-fade can be moderately helpful in some patients with persistent facial erythema for short-term (several hours) results. Many patients had some degree of dermal irritation from the treatment, and about a quarter of patients actually got worse with treatment.

If you are going to try Rho-fade for your persistent facial erythema, then you are advised to test a small amount, and not try it for the first time before an important event.

Overall, the V-beam laser for rosacea is still the better choice.

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