van Zuuren E J, Graber M A, Hollis S, Chaudhry M, Gupta A K, Gover M
Dermatology department B1-Q, Leiden University Medical Centre, Albinus dreef 2, Leiden, Netherlands, 2333 ZA.
Cochrane Database Syst Rev. 2005 Jul 20(3):CD003262. doi: 10.1002/14651858.CD003262.pub3.
Rosacea is a common chronic skin condition affecting the face, characterised by flushing, redness, pimples, pustules, and dilated blood vessels. The eyes are often involved. Frequently it can be controlled, but it is not clear which treatments are most effective.
To assess the evidence for the efficacy and safety of treatments for rosacea.
We searched the Skin Group Specialised Register (February 2005), Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2005), MEDLINE (1966 to February 2005), EMBASE (1980 to February 2005), BIOSIS (1970 to March 2002) and the Science Citation Index (1988 to February 2005). Reference lists of trials and key review articles were searched. Relevant manufacturers and experts were contacted.
Randomised controlled trials in people with moderate to severe rosacea were included. Studies judged by the authors to have seriously flawed methodology were excluded.
Study selection, assessment of methodological quality, data extraction and analysis were carried out by two independent authors. Disagreements were resolved by discussion and consensus.
The evidence provided by twenty-nine included studies was generally weak because of poor methodology and reporting. One of our primary outcome measures, 'quality of life', was not assessed in any of the studies. Only two studies of ocular rosacea were included. Pooled data from two trials involving 174 participants indicated that according to the participants, topical metronidazole is more effective than placebo (odds ratio (OR) 5.96, 95% confidence interval (CI) 2.95 to 12.06). Data pooled from three between-patient trials showed a clear improvement in the azelaic acid group; the rates of treatment success were approximately 70 to 80% versus 50% to 55% (OR 2.45, 95% CI 1.82 to 3.28). A within-patient trial of azelaic cream versus placebo could not be pooled with the other three studies, but also showed good evidence of efficacy. Data pooled from three studies of oral tetracycline versus placebo involving 152 participants showed that, according to physicians, tetracycline was effective (OR 6.06, 95% CI 2.96 to 12.42). Some evidence of efficacy of oral metronidazole was provided by one small study.
AUTHORS' CONCLUSIONS: The quality of studies evaluating rosacea treatments was generally poor. There is evidence that topical metronidazole and azelaic acid are effective. There is some evidence that oral metronidazole and tetracycline are effective. There is insufficient evidence concerning the effectiveness of other treatments. Good RCTs looking at these treatments are urgently needed.
酒渣鼻是一种常见的慢性皮肤病，累及面部，其特征为潮红、泛红、丘疹、脓疱和血管扩张。眼睛常受累。该病通常可以得到控制，但尚不清楚哪种治疗方法最有效。
评估酒渣鼻治疗方法的疗效和安全性证据。
我们检索了皮肤组专业注册库（2005年2月）、Cochrane对照试验中心注册库（Cochrane图书馆2005年第1期）、MEDLINE（1966年至2005年2月）、EMBASE（1980年至2005年2月）、BIOSIS（1970年至2002年3月）以及科学引文索引（1988年至2005年2月）。检索了试验的参考文献列表和关键综述文章。联系了相关制造商和专家。
纳入中度至重度酒渣鼻患者的随机对照试验。作者认为方法存在严重缺陷的研究被排除。
由两名独立作者进行研究选择、方法学质量评估、数据提取和分析。分歧通过讨论和达成共识来解决。
由于方法学和报告质量较差，29项纳入研究提供的证据总体较弱。我们的一项主要结局指标“生活质量”在任何研究中均未评估。仅纳入了两项眼部酒渣鼻研究。两项试验共174名参与者的汇总数据表明，据参与者反馈，局部用甲硝唑比安慰剂更有效（比值比（OR）5.96，95%置信区间（CI）2.95至12.06）。三项患者间试验的汇总数据显示壬二酸组有明显改善；治疗成功率约为70%至80%，而安慰剂组为50%至55%（OR 2.45，95%CI 1.82至3.28）。一项壬二酸乳膏与安慰剂的患者内试验无法与其他三项研究合并，但也显示出良好的疗效证据。三项口服四环素与安慰剂的研究共152名参与者的汇总数据表明，据医生判断，四环素有效（OR 6.06，95%CI 2.96至12.42）。一项小型研究提供了口服甲硝唑有效性方面的一些证据。
评估酒渣鼻治疗方法的研究质量总体较差。有证据表明局部用甲硝唑和壬二酸有效。有一些证据表明口服甲硝唑和四环素有效。关于其他治疗方法的有效性证据不足。迫切需要针对这些治疗方法的高质量随机对照试验。
