Hope for rosacea: Cytokinin treatment offers patients a new therapeutic option
By Ilya Petrou, M.D
National report — Several treatment approaches are used for the treatment of rosacea, however no current therapy is considered a panacea for all the symptoms associated with this condition. A recent trial with Pyratine-XR proves to be very effective in treating many of the associated symptoms seen in rosacea, and offers patients a new therapeutic option for this cosmetic thorn.
Pyratine-6 (0.1 percent furfuryl tetrahydropyranyladenine) and pyratine-XR (0.125 percent furfuryl tetrahydropyranyladenine) are second-generation compounds associated with a molecule called kinetin, which have been shown to have a significant therapeutic effect in rosacea. These cytokinin compounds are antioxidants, which positively impact many aspects of skin aging by increasing mitochondrial activity, helping actin and fibroblast function as well as helping in the removal of cellular debris. In the wake of initial therapeutic clinical trial success with pyratine-6 lotion for the treatment of rosacea, Senetek recently completed a clinical study with pyratine-XR lotion in rosacea patients.
In the 48-week study conducted at the University of California, Irvine, 18 patients with mild-to-moderate rosacea received a twice a day treatment with Pyratine-XR lotion. The investigators evaluated inflammatory papule and pustule lesion count, severity of facial erythema and telangiectasias, and participants self-assessed their signs and symptoms of rosacea as well as skin tolerance to the treatment.
Results showed that at 48 weeks, 80 percent of the patients showed an overall clinical improvement including reduction of facial erythema and inflammatory lesions. There was a 90 percent improvement of inflammatory lesions, a 45 percent improvement of erythema and a 28 percent improvement of telangiectasias. In addition, a significant improvement of the skin barrier function from week four through the end of the study was seen, as measured by a decrease in water loss from the skin.
Pyratine-6 was initially studied for photodamage and results showed that in addition to improving fine lines and wrinkles, it also dramatically helped improve erythema. Pyratine-XR is a reformulation of the original compound that appears to be extremely effective in treating the clinical symptoms seen in rosacea, including erythema, inflammatory lesions as well as spider veins.
"Pyratine-XR appears not only to be effective in treating rosacea, but may also be effective for other dermatoses where erythema plays a major role in the symptomatology such as facial redness, inflammatory lesions, telangiectasias, eczema and atopic dermatitis," says Mark Nestor M.D., Ph.D., voluntary associate professor, department of dermatology and cutaneous surgery, University of Miami Miller School of Medicine, Miami.
The three clinical presentations of rosacea include papulopustular, telangiectatic and sebaceous (rhinophyma) type rosacea and all three variants have been amenable to some degree with different treatment approaches. Current treatments for papulopustular type rosacea include oral and topical antibiotics as well as topical metronidazole and azeleic acid, whereas telangiectatic rosacea responds best to laser or IPL therapies. Because rosacea is a chronic condition, therapeutic regimens used are geared for the long-term. According to Dr. Nestor, long-term tolerability and the development of antibiotic resistance, which can be associated with oral and topical antibiotic regimens, are a non-issue with the cytokinin therapy, and is considered one of the major advantages of this novel therapeutic approach.
"The currently used pharmaceutical therapies do not effectively address the erythema associated with rosacea and none of them treat the telangiectasias. Therefore, it is refreshing to have a compound now that can compliment laser or IPL therapy, does not have any side effects and makes the skin look better and at the same time not only decreases the erythema, but also the suppresses exacerbations of rosacea," Dr. Nestor tells Dermatology Times.
Patients in the trial tolerated Pyratine-XR very well and the cosmetic acceptability was very high. The regimen is twice a day with the lotion until improvements are seen which can be as soon as two weeks of therapy. According to Dr. Nestor, any kind of topical therapy, ultimately, has the potential to cause some degree of irritation, but in the trial patients, there was no difference seen here between Pyratine-XR and the vehicle. Pyratine-XR can be used either alone or as an adjunct in patients with rosacea.
"This gives us another option to help us treat our rosacea patients. In addition, Pyratine-XR lotion also seems to improve other aspects of aging skin such as fine lines, roughness and hyperpigmentations," Dr. Nestor says. DT
Disclosure: Dr. Nestor reoports no relevant financial interests.
what is Rosacea
Rosacea is a common chronic inflammatory disorder of the hair follicles, sebaceous glands and vasculature of the face. The role of Demodex mite in the pathogenesis of Rosacea is controversial.
Rosacea sufferers have recurrent flushing, exacerbated by heat (shower, hot drinks), spicy foods, sunlight, cold, alcohol, and stress. They have sensitive skin, and may complain of dry and gritty eyes.
The peak incidence of Rosacea is 30—50 yr; Females being more affected than Males.
Rosacea sufferers may develop erythema, telangiectases, papules, and pustules of central face; there are no comedones in contrast to acne. Sebaceous hyperplasia, seborrheic dermatitis and facial lymphedema are also more common.
There are 4 Major Subtypes of Rosacea:
Erythematotelangiectatic, papulopustular, ocular, and phymatous.
Chronic inflammation may progress to rhinophyma (enlarged nose; in males). Ocular involvement is also common (e.g., gritty, conjunctival injection, styes, photophobia).
Investigations include clinical diagnosis; uncommonly, skin biopsy is indicated to rule out lupus or sarcoidosis.
Similar conditions that needs to be differentiated from Rosacea are: Acne, lupus erythematosus, perioral dermatitis, sarcoidosis, seborrheic dermatitis.
Treatment of Rosacea is based on severity and subtype.
Lifestyle modification:
Avoid triggers; sun protection and avoidance; facial massage for lymphedema.
Topical antibiotics:
Metronidazole 0.75% gel or 1% cream bid.
Sodium sulfacetamide lotion 10% bid.
Oral antibiotics (moderate to severe cases with inflammatory papulopustular component):
Tetracycline 500 mg po bid
Minocycline 100 mg po od—bid.
Doxycycline 20 mg po bid (subantimicrobial dose therapy) or 100 mg po qd–bid.
Isotretinoin (low dose); less commonly, topical retinoids may be used.
Laser therapy (e.g., PDL, IPL) for telangiectases and ablative laser (e.g., CO2) for rhinophyma.
Camouflage makeup (e.g., Dermablend, Covermark) for erythema.
Ophthalmologist to assess for ocular Rosacea (blepharitis, conjunctivitis, episcleritis).
