Rosacea is a chronic inflammatory skin condition that commonly presents with persistent facial
erythema with or without the coincident presence of
flushing,
telangiectasias, inflammatory papules or pustules, phymatous changes, or ocular involvement. Patients often present with a constellation of various signs and symptoms of the disease, and an individualized treatment plan should be tailored to a patient's unique clinical presentation. Previously available medications for
rosacea have all targeted the inflammatory erythematous papules and pustules frequently associated with the disease, leaving a therapeutic gap for the common manifestation of persistent facial
erythema.
Brimonidine tartrate 0.33% gel was approved by the US Food and Drug Administration in August 2013 as the first medication available for the topical treatment of persistent facial
erythema associated with
rosacea.
Brimonidine gel is a highly selective α2-adrenergic receptor agonist with potent vasoconstrictive effects, which leads to significant reduction of persistent facial
erythema in the majority of patients when applied once daily. Based on large-scale clinical trials and post-marketing reports,
brimonidine gel has maintained a good safety profile with a minority of patients experiencing adverse effects from its use, most of which are cutaneous in nature, mild-to-moderate in degree, occur early after initiation of treatment, often resolve spontaneously with continued use, and generally resolve after discontinuation of use. Among the reported adverse effects, two distinct manifestations of worsened
erythema have been described.
Brimonidine gel can be integrated into a treatment regimen along with concomitant
therapies for facial papules and pustules with no increased risk of adverse events with combination
therapy. Education about optimal application methods, setting reasonable expectations for treatment, and minimizing
inflammation are important factors for the successful use of
brimonidine gel as part of a patient's overall
rosacea treatment regimen.