Topical benzyl benzoate (BB) and crotamiton is effective for controlling symptoms of rosacea and demodicosis, particularly when applied twice daily at 12% or once daily at 20%, a study in the Journal of the European Academy of Dermatology and Venereology reports.

A total of 117 patients with rosacea and 277 patients with demodicosis were included in this retrospective analysis of an earlier observational study. Patients received either once-daily BB and crotamiton at 12% (n=195), twice-daily BB and crotamiton at 12% (n=171), or once-daily BB and crotamiton at 20% (n=28). At initial consultation and follow up, researchers measured Demodex densities (Dds) with 2 consecutive standardized skin surface biopsies (superficial [SSSB1] and deep [SSSB2]). Treatment was considered effective if Dds normalized (SSSB1 ≤5 D/cm2 and SSSB2 ≤10 D/cm2) or if symptoms cleared, whereas treatment was considered curative if both of these 2 terms were met.

There was a 72.4±2.6% reduction in the total Dd (SSSB1 + 2) from initial consultation to the mean follow-up period of 2.7 months. Approximately 35% and 31% of patients experienced normalization of Dds and clearance of symptoms, respectively. In addition, treatment with BB plus crotamiton was considered effective in 46% and curative in 20% of patients, respectively. A higher proportion of men experienced symptom clearance than women (34% vs 20%, respectively; P =.041). The majority of patients (77%) complied with treatment, with few differences observed in those with rosacea and demodicosis. The once-daily 12% treatment regimen was less effective than the other 2 doses and was also associated with lower compliance than the twice-daily 12% dose.

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Limitations of the study included its retrospective design and the small number of patients in the once-daily 20% group.

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The researchers concluded that their findings indirectly support “a key role of the mite in the pathophysiology of rosacea.”

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Forton FMN, De Maertelaer V. Treatment of rosacea and demodicosis with benzyl benzoate: effects of different doses on Demodex density and clinical symptoms [published online September 7, 2019]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.15938