Papulopustular Rosacea Improvement Sustained With Artemether Emulsion

Papulopustular rosacea
Artemether emulsion improved papulopustular rosacea compared to metronidazole emulsion as early as 4 weeks, but its beneficial effect was maintained through the 8-week follow-up in contrast to the effects of metronidazole emulsion.

Improvement with artemether emulsion for the treatment of papulopustular rosacea was superior to treatment with metronidazole emulsion, according to a study published in the Journal of Dermatological Treatment.  

In this investigator-blinded, randomized, parallel group study conducted in China, patients aged ≥18 years with grade 1 to 4 papulopustular rosacea (N=130) were randomly assigned 1:1 to receive either artemether emulsion (1%) or metronidazole emulsion (3%). Each medication was administered twice daily. Exclusion criteria included known allergies to any component of the formula; a mental condition that did not permit good compliance; treatment with any topical, cosmetic, or systemic treatment; and lactation, immune deficiency, oral cavity infection, and previous history of skin cancer in affected areas.

All patients were evaluated at baseline and at week 4, at which times 2 photographs were taken in daylight. Efficacy was based on the total score of erythema and papules and pustules. Safety was determined by the occurrence of systemic and local adverse events and local tolerance parameters.

The mean baseline erythema scores and papule and pustule scores were comparable between the 2 treatment groups, but the effective response rate at week 4 was numerically higher in the patients who received artemether emulsion compared with the patients who received metronidazole emulsion (54 of 62 [87.1%] vs 48 of 60 [80%]; P =.29). However, patients in the artemether emulsion group had significantly lower mean papule and pustule scores compared with patients in the metronidazole group (0.21±0.52 vs 0.42±0.83; P =.001).

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During the open-label 8-week follow-up period, the relapse rate was significantly lower for patients in the artemether emulsion group compared with patients in the metronidazole emulsion group (1 of 60 [2.4%] vs 8 of 62 [21.6%]; P =.033). There were no major adverse events noted in either treatment group through 12 weeks. Tolerance was excellent for all patients in both groups.

The researchers suggested that the findings were used to demonstrate the efficacy (erythema, papules, and pustules) and tolerance (safety and relapse) of topical 1% artemether emulsion for the treatment of rosacea. The proportion of patients receiving artemether emulsion that maintained clinical remission or clinical response was substantially higher compared with the proportion of patients who received metronidazole emulsion, through the open-label 8-week follow-up. Further studies with larger sample sizes are needed to determine the minimal effective concentration needed to maintain remission, in addition to the long-term safety and efficacy of artemether emulsion in patients with papulopustular rosacea.  

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Wang GJ, Gao XY, Wu Y, et al. Evaluation of the efficacy and tolerance of artemether emulsion for the treatment of papulopustular rosacea: a randomized pilot study [published online on April 24, 2019]. J Dermatolog Treat. doi: 10.1080/09546634.2019.1610549