Is permethrin 5% cream effective for rosacea?

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Q&A

Is permethrin 5% cream effective for rosacea?

J Fam Pract. 2003 March;52(3):183-200

By

Elizabeth M. Swenor, DO

BACKGROUND: The skin mite D folliculorum has been implicated as a cause of rosacea. However, other possible causes include a genetic predisposition, psychogenic factors, gastrointestinal diseases, and seborrhea. Permethrin is a topical insecticide effective against a wide variety of arthropods, including D folliculorum.
POPULATION STUDIED: These researchers studied 63 patients, ages 20 to 80 years, with papulopustular rosacea. The duration of disease was 0.17 to 15 years (mean 2.9 years). Study participants were selected from an outpatient dermatology clinic in Ankara, Turkey; 48 women and 15 men. A diagnosis of papulopustular rosacea was based on clinical and histopathological findings. Patients were eligible if they had at least 10 inflammatory papules or pustules. Exclusion criteria were erythematotelangiectatic rosacea, fulminant rosacea, systemic treatment of the eyes, and use of oral anticoagulants.
STUDY DESIGN AND VALIDITY: This study was a randomized, double-blind trial in which patients with papulopustular rosacea were assigned to one of three topical treatments: permethrin 5% cream, metronidazole 0.75% gel, or placebo. Patients were provided with and encouraged to use sunscreen. All patients were followed for a total of 60 days. The authors did not specifically state whether the treatment allocation was concealed or if all patients completed the study.
OUTCOMES MEASURED: The primary outcomes for this study were the change in the number of papules and pustules, change in erythema scores (assessed on a scale from 0 to 3), and counts of D folliculorum. Comparisons were made based on change from baseline at day 0 to day 60, with additional analyses comparing changes at each assessment on days 15, 30, 45, and 60. Secondary outcomes included telangiectasia, edema, rhinophyma, and side effects of the topical treatments.
RESULTS: Using intention-to-treat analysis, permethrin 5% cream was as effective as metronidazole 0.05% gel and significantly superior to placebo at improving erythema (change from a baseline score of 2.60 to 1.34), papules (change from baseline count of 6.04 to 1.73), and pustules (change from baseline count of 2.30 to 0.56).

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Is permethrin 5% cream effective for rosacea?

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