Topical Tranexamic Acid Cost Effective Treatment for Erythematotelangiectatic Rosacea

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Rosacea more often is evident after the age of 30 years, peaking between the ages of 40 and 50 years.
Rosacea more often is evident after the age of 30 years, peaking between the ages of 40 and 50 years.

The use of topical tranexamic acid solution is a new and promising low-cost treatment option for patients with erythematotelangiectatic rosacea. It has proven to be safe and easy to use, targeting primarily the vascular network and erythema of rosacea, according to the results of a prospective, parallel, randomized, nonblinded, open-label, comparative study conducted at the Andreas Syggros Hospital in Athens, Greece. Findings from the study were published in the Journal of Cosmetic Dermatology.

The investigators sought to evaluate the efficacy of tranexamic acid applied topically on affected areas in patients with erythematotelangiectatic rosacea. Because tranexamic acid is an antifibrinolytic agent that works by preventing blood clots from breaking down too quickly, its use in patients with erythematotelangiectatic rosacea, which is characterized by a vascular net and erythema, might prove to be effective.

A total of 20 patients with erythematotelangiectatic rosacea were enrolled in the study. All the participants were women between 27 and 65 years of age. Eligible enrollees all had "severe" to "minimal" erythema of rosacea, erythematotelangiectatic subtype, based on the Investigator Global Assessment of Rosacea Severity Score (IGA-RSS). In the IGA-RSS, a 7-point numerical scale from 0 to 6 is used to describe patients' rosacea symptoms (0, clear; 1, minimal; 2, mild; 3, mild to moderate; 4, moderate; 5, moderate to severe; 6, severe). All patients also were given a Dermatology Life Quality Index questionnaire to complete to evaluate their rate of satisfaction. Clinical and dermoscopy pictures were taken before each treatment and 15 days after the last treatment session to assess the results.

All participants were randomly assigned in a 1:1 ratio to 1 of 2 groups, with 10 individuals in each group: group A: participants were treated with tranexamic acid 5 mL solution (transamin inj/sol 500 mg/5 mL) infused wet dressing for 20 minutes; group B: participants were treated with microneedling (0.5 cm) in combination with tranexamic acid solution topical application (5 mL), followed by tranexamic acid solution-infused dressing therapy for 20 minutes. Sessions were repeated every 15 days in all participants until they had undergone 4 treatments.

All patients in both groups A and B demonstrated statistically significant improvement after 4 sessions of tranexamic acid therapy (P <.05). Changes in IGA-RSS were reported in both treatment groups: 70% (7 of 10) of participants in group A and 80% (8 of 10) of participants in group B. On the basis of analysis by chi-square and Fisher's exact test, a significant difference in IGA-RSS of ≥3 units was reported in the group that used microneedling (P <.05).

The investigators concluded that additional studies are warranted to verify these results. Major limitations of the study include the fact that it was not blinded in nature, which generates a degree of patient bias and observer bias with respect to subjective scoring. Moreover, the study period was relatively short, and the patients sample was quite small.

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Reference

Bageorgou F, Vasalou V, Tzanetakou V, Kontochristopoulos G. The new therapeutic choice of tranexamic acid solution in treatment of erythematotelangiectatic rosacea [published online August 11, 2018]. J Cosmet Dermatol. doi: 10.1111/jocd.12724

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