Clinical Question: Is permethrin cream effective in the treatment of rosacea?

Setting: utpatient (specialty)

Study Design: Randomized controlled trial (double-blinded)

Synopsis: Demodex folliculorum, a skin mite, has been identified as a cause of rosacea. Permethrin cream is active against mites, ticks, lice, and fleas, and thus may be helpful in treating rosacea. To determine its efficacy, 63 patients 20 to 80 years of age who were diagnosed with papulopustular rosacea were randomly assigned to twice-daily application of permethrin cream, 5 percent; metronidazole gel, 0.75 percent; or an identical placebo cream. All patients also were encouraged to use sunscreen with a skin protection factor of 20. The authors do not specify whether the people who assessed the outcomes were blinded to treatment assignment. All patients were followed for 60 days.

Using intention-to-treat analysis, permethrin cream was as effective as metronidazole gel and significantly superior to placebo at improving erythema (baseline score: 2.6; 1.3 versus 2.6 at day 60), papules (baseline score: 6; 1.7 versus 5 at day 60), and pustules (baseline score: 2.3; 0.6 versus 2.4 at day 60). Neither permethrin nor metronidazole had any significant effect on telangiectasia or rhinophyma. No complications or adverse effects were reported.

Bottom Line: Permethrin 5 percent cream is as effective as metronidazole 0.75 percent gel and superior to placebo in the treatment of rosacea. This medication should be added to the arsenal of creams that combat this frustrating skin disease. (Level of Evidence: 1b)