Adjunctive Natural Skin Care Regimen Effective and Well Tolerated in Rosacea

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Investigators sought to determine the efficacy and tolerability of natural regimen vs synthetic regimen for the treatment of rosacea concomitantly treated with metronidazole.

A natural skin care regimen was superior to a dermatologist-recommended synthetic regimen used as concomitant therapy to metronidazole in managing rosacea, according to a study published in the Journal of Drugs in Dermatology.

The investigators of this double-blinded study sought to compare the efficacy and tolerability of a natural skin care regimen with a synthetic dermatologist-recommended regimen as adjunctive to prescription therapy in patients with rosacea.

The study included 80 women aged 25 to 70 years with moderate to severe facial rosacea. All participants were treated with 0.75% metronidazole gel twice a day for a 6-week open-label period. After this phase, the participants were randomly assigned in a 1:1 ratio to receive the natural regimen or the synthetic regimen (control) as add-on therapy; both regimens were applied twice daily for 4 weeks in conjunction with metronidazole gel.

The natural regimen consisted of a cleanser (containing natural oils, beeswax, and witch hazel) and day and night creams (containing natural oils, glycerin, and botanical anti-inflammatories). The synthetic regimen consisted of a cleanser (containing cetyl alcohol and sodium lauryl sulfate) and a moisturizer (containing glycerin and polyisobutene). The primary outcome was the global assessment of rosacea; study investigators and participants rated overall skin appearance using a 5-point scale (0=no rosacea, 1=minimal rosacea, 2=mild rosacea, 3=moderate rosacea, 4=severe rosacea) at baseline, week 2, and week 4. Barrier function and skin hydration were also assessed using noninvasive measures.

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At week 4, participants receiving the natural regimen showed a significant improvement in investigator global assessment of rosacea: Erythema improved by 28%, telangiectasia improved by 26%, and papules/pustules improved by 34% (P <.001). In comparison, those using the control regimen improved 8% to 12%, with only the change in telangiectasia achieving statistical significance (P =.019). Study investigators found that participants’ overall skin appearance was clinically and statistically improved from baseline by 32% in those using the natural care regimen and by 12% in those using the control regimen. Self-rating of overall skin appearance showed improvement from baseline in both groups, with no differences in cosmetic parameters reported between treatments. From baseline to week 4, barrier function was comparably improved in both groups: by 13% with the natural regimen and by 14% with the control regimen. In addition, the water content of the skin decreased by 21% (P <.001) in the group using the natural regimen, whereas the hydration was increased by 14% in the control group. Natural and synthetic regimens revealed no clinically significant issues with tolerability.

A limitation of this study, as reported by the authors, was the current lack of natural preservatives in nature-sourced skin care formulations. These synthetic preservatives are necessary to support shelf-life requirements.

Study investigators suggested this research demonstrates the value of a concomitant natural skin care regimen to improve moderate to severe rosacea in patients undergoing topical metronidazole therapy. They further concluded that natural skin care ingredients are effective, well tolerated, and superior compared with synthetics in improving skin parameters and barrier function.


Study authors reported affiliation with Burt’s Bees.

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Draelos ZD, Gunt H, Levy SB. Natural skin care products as adjunctive to prescription therapy in moderate to severe rosacea. J Drugs Dermatol. 2019;18(2):141-146.