Rozasede topikal tedavi seçenekleri: güncel bir derleme

Öz

Amaç: 2020–2026 yılları arasındaki güncel kanıtları değerlendirmek ve rozasede fenotip temelli tedavi stratejilerini, bireyselleştirilmiş ve klinik pratiğe uygulanabilir yaklaşımlar çerçevesinde özetlemek. Gereç ve Yöntem: 2020–2026 yılları arasında yayımlanan güncel klinik kılavuzlar, randomize kontrollü çalışmalar ve sistematik analizler incelendi. Tedavi seçenekleri baskın klinik özellikler, hastalık şiddeti ve hasta ile ilişkili faktörler doğrultusunda değerlendirildi. Bulgular: Katı alt tip sınıflamasından ziyade, spesifik klinik bulguları hedefleyen fenotip temelli yönetim yaklaşımı önerilmektedir. Papülopüstüler rozasede topikal ivermektin, azelaik asit ve metronidazol ilk basamak tedavilerdir. Düşük doz modifiye salınımlı oral doksisiklin daha düşük nüks oranları ile sürdürülebilir antiinflamatuvar etkinlik göstermektedir. Minosiklin akut inflamatuvar lezyonların azaltılmasında yüksek etkinlik göstermektedir. Eritematotelanjiektatik tabloda topikal vazokonstriktörler hızlı semptom kontrolü sağlarken, oral beta blokerler flushing ve persistan eritemi azaltabilmektedir. Enerji temelli cihazlar eritemde belirgin azalma sağlamaktadır. Orta-ağır hastalıkta kombinasyon yaklaşımları daha üstün sonuçlar göstermektedir. Oküler rozase yönetiminde topikal antimikrobiyaller, oral antibiyotikler ve ışık temelli tedaviler yüksek yanıt oranlarına sahiptir. Düşük doz izotretinoin dirençli papülopüstüler hastalıkta yüksek etkinlik göstermektedir. Mikroenkapsüle benzoil peroksit, kalsitonin gen ilişkili peptid yolak inhibitörleri ve intradermal botulinum toksin gibi yeni tedaviler belirli fenotiplerde umut verici sonuçlar sunmaktadır. Sonuç: Güncel kanıtlar, rozasede baskın klinik özellikler ve hasta özelliklerine göre bireyselleştirilmiş fenotip temelli tedavi seçiminin etkinlik, tolere edilebilirlik ve uzun dönem hastalık kontrolünü optimize ettiğini desteklemektedir.

Anahtar Kelimeler

• rozase
• papulopüstüler rozase
• eritematotelenjiektatik rozase
• oküler rozase

Topical treatment options in rosacea: A current review

Öz

Aim: To evaluate current evidence from 2020 to 2026 and summarize phenotype-based treatment strategies for rosacea, focusing on individualized and clinically practical management approaches. Materials and Methods: Clinical guidelines, randomized controlled trials, and systematic analyses published between 2020 and 2026 were reviewed. Treatment options were evaluated according to dominant clinical features, disease severity, and patient-related factors. Results: Phenotype-based management targeting specific clinical manifestations is favored over rigid subtype classification. For papulopustular disease, topical ivermectin, azelaic acid, and metronidazole remain first-line therapies, while low-dose oral doxycycline provides sustained anti-inflammatory control with reduced relapse rates. Minocycline demonstrates strong efficacy in acute inflammatory lesions. In erythematotelangiectatic presentations, topical vasoconstrictors offer rapid erythema reduction, and oral beta-blockers may improve flushing. Energy-based devices significantly reduce persistent erythema. Combination therapies improve outcomes in moderate-to-severe cases. Ocular involvement responds well to topical antimicrobials, oral antibiotics, and light-based therapies. Low-dose isotretinoin remains effective for severe recalcitrant disease. Emerging treatments, including microencapsulated benzoyl peroxide, calcitonin gene-related peptide pathway inhibitors, and intradermal botulinum toxin, show promising results in selected phenotypes. Conclusion: Recent evidence supports individualized, phenotype-driven treatment strategies in rosacea. Tailoring therapy according to dominant clinical features and patient-specific factors optimizes efficacy, tolerability, and long-term disease control.

Anahtar Kelimeler

• rosacea
• Papulopustular rosacea
• Erythematotelangiectatic rosacea
• Ocular rosacea

Kaynakça

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