Rosacea and treatment with retinoids: a systematic review and meta-analysis

Background: Rosacea is a common inflammatory disease. Four clinical rosacea subtypes have been described, with the papulo-pustular being the most common. At present, the only FDA-approved treatment for papulo-pustular rosacea is low-dose doxycycline. Retinoids, in particular isotretinoin, have shown for decades positive outcomes in the treatment of rosacea, but due to the lack of robust evidence, they are still considered an off-label treatment for this condition. Objectives: Summarize the current evidence in the literature regarding the role of topical and systemic retinoids in the treatment of papulo-pustular rosacea. Design: Systematic review and meta-analysis. Data source and methods: A systematic MEDLINE, EMBASE, and Cochrane search of relevant publications on this topic was carried out. Randomized and non-randomized studies regarding topical and systemic retinoid treatment for rosacea were included. We excluded not relevant studies, case reports, reviews, and non-English language studies. We have used RoB2 and ROBINS-1 tool for assessing risk of bias in randomized and non-randomized trials, respectively. Results: Due to the heterogeneity in study design and outcomes reporting, the standardization of our results is limited, but the findings from this systematic review with meta-analysis indicate that retinoids, particularly isotretinoin, are a promising treatment option for papulopustular rosacea, with a favorable tolerability and safety profile. On the other hand, available data for topical retinoid therapy are less definitive and more contradictory, with only two randomized studies reporting opposite outcomes. Conclusion: Retinoids may be a valid treatment option for rosacea, but larger, randomized controlled trials are needed to establish standardized dosing regimens and long-term safety profiles.