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FA L L C L I N I C A L D E R M AT O L O G Y C O N F E R E N C E P R O C E E D I N G S
Unlike anti-inflammatory dose doxycycline, doxycycline
100 mg daily administered over a 2-week period has been
shown to select for multiple resistant organisms within 7 days,
with more than 32.2% of organisms obtained from nasopharyngeal
cultures demonstrating resistance to doxycycline as
compared to 2.2% at baseline. Doxycycline 50 mg once daily
achieves serum levels that exceed the minimum inhibitory
concentration (MIC) of several bacteria for 2 to 4 hours.
A study evaluating the combination of metronidazole gel 1%
( M e t roGel 1%) and anti-inflammatory dose doxycycline
(Oracea), both used once daily, confirmed that the combination
regimen produced superior therapeutic benefit as compared to
topical metronidazole alone in patients with inflammatory
rosacea. After 4 weeks, the combination regimen pro d u c e d
essentially the same reduction in inflammatory lesions that was
achieved with metronidazole gel 1% over 12 weeks (F i g u re 7) .
A recent trial demonstrated that azelaic acid gel 15%
(Finacea) once daily is therapeutically equivalent to twicedaily
application in subjects with inflammatory ro s a c e a
(F i g u re 8). Study endpoints utilized quantitative, qualitative,
and static assessments, including lesion count evaluations
and global assessments. Once-daily use of azelaic acid gel
15% is more likely to be associated with optimal compliance
and offers a cost benefit over time as compared to
twice-daily application.
T R O L A M I N E - C O N TAINING TO P I C A L E M U L S I O N
Trolamine-containing topical emulsion (Biafine) is an oil-inwater
formulation that has been used for more than 3 decades
in both the United States and Europe. The mechanism of
action of trolamine-containing topical emulsion appears to be
p romotion of an increase in the number of macro p h a g e s
recruited to the injury site, thereby reducing the time needed for
healing. Macrophages promote wound healing and serve a
central role in directing the course and pro g ression of the
wound-healing process. Therapeutic applications for tro l a m i n e -
containing topical emulsion include full-thickness wounds,
superficial wounds, including those that are postoperative, dermal
ulcers, radiation dermatitis, minor abrasions, actinic keratosis
treatment sites after cryotherapy, and wounds that
re q u i re second-intention healing after dermatologic surgery.
The use of trolamine-containing topical emulsion for the
t reatment of radiation dermatitis has made it possible to
reduce overall treatment time of chemotherapy and radiotherapy
because the modalities could be administered simultaneously
rather than sequentially. Additionally, tro l a m i n e - c o n t a i n-
ing topical emulsion differs from topical neomycin and bacitracin
because the latter 2 agents are well recognized as common
causes of contact allergy.
References
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formulation of minocycline hydrochloride tablets. Cutis. 2006;78(4
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e x t e n d e d - release formulation of minocycline. C u t i s. 2006;78(4
Suppl):21–31.
4. Del Rosso JQ. Scientific panel on antibiotic use in dermatology. Submitted
for publication 2008.
5. Del Rosso JQ, Webster GF, Jackson M, et al. Two randomized phase III
clinical trials evaluating anti-inflammatory dose doxycycline (40-mg doxycycline,
USP capsules) administered once daily for treatment of rosacea. J Am
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on emergence of antibiotic resistance. Presented at the Fall Clinical
Dermatology Conference in Las Vegas, NV, October 18–21, 2007.
8. Fowler JF Jr. Combined effect of anti-inflammatory dose doxycycline (40-
mg doxycycline, USP monohydrate contro l l e d - release capsules) and
metronidazole topical gel 1% in treatment of rosacea. J Drugs Dermatol.
2007;6(6):641–645.
9. Fleischer AB, Thiboutot D, Del Rosso JQ. Comparison of azelaic acid gel
15% once daily versus twice daily in the treatment of rosacea. Presented at
the World Congress of Dermatology in Buenos Aires, Argentina, October
1–5, 2007.
10. Data on file. Allergan Inc., Irvine, CA, 2008.
11. Del Rosso JQ, Tanghetti E. The clinical impact of vehicle technology
using a patented formulation of benzoyl peroxide 5%/clindamycin 1% gel:
comparative assessments of skin tolerability and evaluation of combination
use with a topical retinoid. J Drugs Dermatol. 2006;5(2):160–164.
12. Del Rosso JQ. Study results of benzoyl peroxide 5%/clindamycin 1%
gel, adapalene 0.1% gel, and use in combination for acne vulgaris. J Drugs
Dermatol. 2007;6(6):616–622.
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tazarotene plus clindamycin/benzoyl peroxide in the treatment of acne vulgaris:
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Dermatol. 2006;5(3):256–261.
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