Topical Oxymetazoline and Brimonidine Reduce Facial Erythema in Patients With Rosacea

woman applying cream to face
woman applying cream to face
Vasoconstrictors oxymetazoline and brimonidine achieve significant success in improving erythema in patients with rosacea.

In patients with persistent facial erythema associated with rosacea, treatment with topical oxymetazoline and brimonidine is effective for conferring noticeable improvements in erythema, a review article in the Journal of Dermatological Treatment suggests.

The study was an analysis of phase 2 and phase 3 trials that enrolled patients with moderate to severe rosacea who were treated with oxymetazoline and brimonidine topical therapies.

A total of 2 phase 3 trials that assessed efficacy and safety of brimonidine were included (n=553). Clinician erythema assessment (CEA) and subject self-assessment (SSA) were used to assess changes in erythema from baseline. Primary endpoint was the 2-grade improvement on CEA and SSA for facial redness associated with rosacea at post-dose hours 3, 6, 9, and 12 on day 29. In the phase 3 trial, a greater proportion of patients who were treated with brimonidine achieved at least 2-grade or more composite improvement in CEA and SSA vs patients in the vehicle group at each time point (P ≤.02) as well as overall (P <.001).

In a 12-month phase 3 trial, researchers assessed efficacy and safety of a 0.5% brimonidine gel in a similar patient population. There was a gradual reduction in the mean Patient Self-Assessment (PSA) on day 1 at hour 0 to hour 3 from 3.1 to 2.1, respectively. Improvements in erythema, based on the PSA, also decreased from 2.2 to 1.5 at the same time points. Another 8-day randomized, vehicle-controlled study found a 1 grade or more improvement from baseline to day 8 in CEA in patients treated with brimonidine vs vehicle control (71.7% vs 35.7%, respectively; P =.0011). Additionally, a greater proportion of patients treated with brimonidine had an improvement in PSA score (76.1% vs. 47.6%, respectively; P =.004). Topical brimonidine had a good tolerability profile in the overall trials.

Oxymetazoline was evaluated in 2 identical vehicle-controlled phase 3 trials (n=885), which found that the drug was associated with a higher proportion of patients achieving a 2 grade or more composite improvement in CEA and SSA compared with vehicle control (P <.001). Another phase 3 trial of 440 patients with rosacea treated with oxymetazoline found that the therapy was associated with 36.7% and 43.4% of patients achieving a 2-grade improvement in CEA and SSA scores from baseline to hours 3 and 6.

Related Articles

Limitations of the studies in the review were the narrow demographic ranges, the predominantly white patient population, and the lack of longer-term data on the 2 drugs.

According to the authors, addressing the studies’ limitations would “help clinicians to make more informed decisions when using these medications.”

Disclosure: None of the study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Follow @DermAdvisor


Okwundu N, Cline A, Feldman SR. Difference in vasoconstrictors: oxymetazoline vs brimonidine [published online July 11, 2019]. J Dermatolog Treat. doi:10.1080/09546634.2019.1639606