Do We Have A Cure For Rosacea?

The current  Rosacea Pipeline therapies include FMX103 (Foamix Pharmaceuticals), Epsolay (Sol-Gel Technologies), ACU-D1 (Accuitis), HY01 (Hovione Scientia Limited), AFX4031 (Afecta Pharmaceuticals), AOB103 (AOBiome), and others. The therapies intend to address the unmet needs in the Rosacea treatment market.

Awareness about any condition is as important as treating the condition itself. Similar is the case with, Rosacea, a characteristic inflammatory condition affecting the skin especially the face resulting in facial erythema or redness. Around one in 10 people in the world is affected by rosacea.

The condition can be controlled differently; however, there is no standard cure for the disease.  The treatment also varies with the subtype of rosacea. The treatment is prescribed according to the dominant features of the disease.  

The current Rosacea therapeutic landscape is divided into four major categories based on the route of administration and the approved usage for the condition. These are topical retinoids, topical antibiotics, oral tetracycline-class antibiotics (TCAs), and oral retinoids. Topical retinoids comprise Tretinoin, Tazarotene, Adapalene, and Clindamycin/tretinoin, along with several other topical therapies that are used to reduce erythema, papules and pustules, and telangiectasias. Tretinoin is the most commonly used and cost-effective topical retinoid. Topical antibiotics, such as metronidazole (e.g. Metrolotion), clindamycin, erythromycin, azelaic acid (e.g. Fincea), benzoyl peroxide, benzoyl peroxide/clindamycin, benzoyl peroxide/erythromycin, sulfacetamide, and sulfacetamide/sulfur, are directly applied to the skin to kill the pathogens, metronidazole being the most commonly used followed by clindamycin, erythromycin, and azelaic acid. In general, sun avoidance and photoprotection are necessary to manage the condition. Skincare routine, including gentle cleanser and moisturizer, improves the therapeutic value of the antibiotics. However, Topical therapies are given a few months, and Topical corticosteroids are avoided.

Furthermore, oral drugs are available for the treatment of flushing and erythema. Oral tetracycline (TCA) comprises the use of tetracycline, minocycline, and doxycycline (Oracea). They are the anti-inflammatory agents that do not result in bacterial resistance. Of all the Oral TCAs, tetracycline occupies the major share of the chunk of prescriptions, followed by minocycline and doxycycline. Then there are Oral retinoids that involve isotretinoin (e.g. Accutane). Isotretinoin is an FDA and EMA-approved therapy for the treatment of acne and is available as off-label therapy in the rosacea treatment market. 

Furthermore, it is important to carefully study the condition since its pathophysiology and cause remains a mystery. Rosacea management also involves avoiding triggers such as extreme temperatures, exposure to UV rays, allergic food, or beverage, or specific weather conditions.

Some of the approved therapies to bring relief from the symptoms of the condition include Rhofade (topical oxymetazoline), Mirvaso (brimonidine) topical gel, Finacea (azelaic acid) Foam, Oracea (doxycycline), Soolantra (ivermectin 1% cream), and MetroGel (metronidazole) gel. Recently, in March 2019, Perrigo, an Irish manufacturer of private label over-the-counter pharmaceuticals, received FDA approval for the generic version of Finacea Foam 15%, which the company acquired through a patent litigation suit with Bayer AG. In similar lines, LEO Pharma acquired Finacea Foam 15% from Bayer AG and then substituted for Bayer AG as the lead plaintiff in the patent litigation suit concerning the product. Besides Perrigo, Glenmark also received FDA-approval for azelaic acid gel, 15%, a generic version of Finacea gel. 

Albeit, Topical medications coupled with anti-inflammatory medications are effective in improving symptoms and providing relief from pimples and pustules; however, the erythema of rosacea remains untended. Moreover, the available over-the-counter drugs may trigger and worsen rosacea if paired up with calcium channel blockers, sildenafil, and some vitamin B-related medications. However, there are drugs in the pipeline that are designed to address these unmet needs in the rosacea treatment market. However, educating people about rosacea is imperative and needs attention. The condition remains highly underdiagnosed and is frequently misdiagnosed as acne. Pharma players such as Foamix Pharmaceuticals, Sol-Gel Technologies, Accuitis, Hovione Scientia Limited, Afecta Pharmaceuticals, and AOBiome are developing novel therapies to meet the unmet needs of the rosacea treatment market. The current Rosacea Pipeline therapies include FMX103 (Foamix Pharmaceuticals), Epsolay (Sol-Gel Technologies), ACU-D1 (Accuitis), HY01 (Hovione Scientia Limited), AFX4031 (Afecta Pharmaceuticals), AOB103 (AOBiome), and others.

Without a doubt, Rosacea is a challenging condition. With a lack of proper knowledge, it becomes difficult to provide a proper treatment regimen. However, educating people and making them aware of the condition can help avoid triggers, bundled with medical management of the condition to reduce the redness that comes with rosacea.