The Rosacea Revolution: Unveiling Paroxetine's Success in Tackling Persistent Erythema

Original Article: Paroxetine is an effective treatment for refractory erythema of rosacea: Primary Results from the Prospective Rosacea Refractory Erythema Randomized Clinical Trial

What are the key takeaways of this article?

This study aimed to evaluate the safety and efficacy of paroxetine, a selective serotonin reuptake inhibitor, in patients with moderate to severe refractory rosacea. In a multicenter, prospective double-blind placebo study, researchers found that paroxetine exhibited favorable safety and efficacy outcomes after 12 weeks of treatment. Paroxetine demonstrated tolerability and effectiveness in achieving clinical erythema assessment (CEA) success, defined as a score of 0 or 1, or an improvement of more than 2-grade points from baseline. Furthermore, patients who were treated with paroxetine also exhibited improvements in flushing, burning sensation, and depression compared to those receiving placebo.

Currently, the standard treatments of rosacea are limited. These treatments include oral doxycycline, as well as topical brimonidine and oxymetazoline, which have only shown partial effectiveness and rebound erythema. Paroxetine, on the other hand, has been previously shown to be efficacious in targeting vascular dysregulation and has been successfully utilized in the treatment of menopausal hot flashes. The success of SSRI’s in rosacea and hot flashes is due to the theory of serotonin (5HT) dysfunction in association with vessel dilation and abnormal constriction, which is observed in these inflammatory diseases.

To conduct this study, 97 patients between the ages of 18 and 65 with a clinical diagnosis of refractory erythema of rosacea were followed. Refractory erythema was defined as the persistent presence of symptoms despite a minimum of 3 months of tetracycline treatment (with or without light therapy) and combined topical treatment. Patients included in the study had a CEA score of greater than or equal to three. Patients who met the predefined inclusion criteria were randomly assigned to either the treatment or the control group. Those in the treatment group were given a daily oral dose of 25 mg of paroxetine.

Among patients taking paroxetine, CEA success was seen in 42.9% compared to 20.8% seen in the placebo group. Flushing improvement was reported in 44.9% of individuals taking paroxetine, whereas 25% showed improvement in the placebo group. The improvement of inflammatory lesions was not statistically significant between the placebo and paroxetine groups. However, the total lesion count at 12 weeks was lower in those taking paroxetine (5.89) than those in the placebo group (12.79), although the difference was not statistically significant. Burning sensation showed a significant difference between groups, with 46.9% of individuals in the paroxetine group experiencing improvement compared to only 18.8% of individuals in the placebo group. The assessment of quality of life using the RosaQoL score, as well as scores used for stress and anxiety, did not demonstrate any significant differences between groups. However, there was an improvement in depression among patients in the paroxetine group, with a 20.4% improvement as opposed to 6.3% seen in the placebo group. All patients were monitored for adverse events (AEs). In general, those treated with paroxetine reported dizziness, lethargy, nausea, dyspepsia, and muscle tremors.

In conclusion, the treatment of paroxetine demonstrated efficacy in improving primary markers as defined by investigators. In patients with refractory erythema of rosacea, a 12-week treatment with paroxetine resulted in improvements in erythema, flushing, and burning sensations, although there was no significant improvement in inflammatory lesions. This represents an important advancement in rosacea treatment, particularly for the management of erythema and flushing, as there are currently limited regimens available. The efficacy of paroxetine can be attributed to its ability to stabilize vascular function. Unlike placebo patients who exhibited a plateau CEA success (a score of 0 or 1 or at least a 2-grade improvement from baseline response) at 12 weeks, those receiving paroxetine showed a sustained increase in response over the course of 12 weeks. Further trials are needed to investigate different dosing regimens and treatment durations in order to better understand the full extent of the potential advantages provided by paroxetine in managing rosacea.

Publication Date: June 19th, 2023

Reference: Wang B, Huang Y, Tang Y, Zhao Z, Shi W, Jian D, Liu F, Gao Q, Wang P, Yang J, Li L. Paroxetine is an effective treatment for refractory erythema of rosacea: Primary results from the Prospective Rosacea Refractory Erythema Randomized Clinical Trial. Journal of the American Academy of Dermatology. 2023 Feb 15.

Summary By: McKenzie Van Eaton