What is the proper use and treatment protocol for Arazlo (topical cream) in managing rosacea?

From the Guidelines

Arazlo (tazarotene 0.045% lotion) is not FDA-approved for rosacea treatment and should not be used for this condition. Arazlo is specifically indicated for acne vulgaris, not rosacea. For rosacea management, more appropriate topical medications include metronidazole (MetroGel, MetroCream), azelaic acid (Finacea, Azelex), ivermectin (Soolantra), or brimonidine (Mirvaso) 1. These medications target the inflammation and vascular changes characteristic of rosacea, whereas Arazlo is a retinoid that can potentially worsen rosacea symptoms by increasing skin irritation, dryness, and sensitivity.

Key Considerations for Rosacea Treatment

• General skincare measures, such as sun protection and gentle cleansers, are essential for managing rosacea 1.
• A phenotype-led approach to rosacea management is recommended, addressing individual rosacea features such as transient erythema, persistent erythema, inflammatory papules/pustules, telangiectasia, and phyma 1.
• First-line treatments for rosacea features include:
  • Transient erythema: topical α-adrenergics, such as brimonidine, or oral beta blockers, such as carvedilol 1.
  • Inflammatory papules/pustules: oral doxycycline, azelaic acid, or ivermectin 1.
• Maintenance treatment depends on the treatment modality and patient preferences, and may involve the use of multiple agents to address multiple features simultaneously 1.

Importance of Proper Diagnosis and Treatment

If a patient with rosacea were mistakenly prescribed Arazlo, they would likely experience increased redness, burning, stinging, and potentially a flare of their condition. Patients with rosacea should consult with a dermatologist for proper diagnosis and treatment with medications specifically designed for rosacea management. The ROSCO panel recommends a phenotype-led approach to rosacea management, incorporating current best evidence and clinical experience to improve outcomes for patients with rosacea 1.

From the Research

Treatment Protocol for Arazlo (Topical Cream) in Managing Rosacea

• Arazlo, a topical cream, is used in the management of rosacea, a chronic facial skin condition characterized by erythema, telangiectasia, inflammatory papules and pustules, or hyperplasia of the connective tissue 2.
• The proper use of Arazlo involves applying the cream topically, twice daily, as part of a comprehensive treatment plan that includes avoidance of triggers, mild cleansing agents, moisturizing regimens, and photoprotection with wide-brimmed hats and broad-spectrum sunscreens (minimum sun protection factor of 30) 2.
• Topical azelaic acid, the active ingredient in Arazlo, is effective in reducing inflammatory lesions and erythema in patients with rosacea, as demonstrated in a multicentre, prospective clinical trial 3.
• The treatment protocol for Arazlo may involve combination therapy with other topical or oral agents, such as brimonidine, ivermectin, metronidazole, or doxycycline, depending on the severity and presentation of the disease 4, 5.

Efficacy and Tolerability of Arazlo

• Studies have shown that Arazlo is effective in reducing the severity of rosacea symptoms, including erythema, papules, and pustules, with significant improvements in Investigator Global Assessment (IGA) scores and inflammatory lesions count 3.
• Arazlo has been found to be well-tolerated, with no relevant side effects reported in clinical trials 3.
• The use of Arazlo as a maintenance therapy has been suggested, given its efficacy and tolerability profile 4.

Combination Therapy with Arazlo

• Combination therapy with Arazlo and other agents, such as topical ivermectin or oral doxycycline, may be beneficial for patients with papulopustular rosacea, as it targets multiple inflammatory pathways involved in the disease 5, 6.
• The complementary mechanisms of action of Arazlo and other agents, such as ivermectin and doxycycline, provide a scientific rationale for combination therapy in the treatment of rosacea 5.