Is paroxetine (Paxil) an effective treatment for refractory erythema in adults with rosacea?
This study found that paroxetine, 25 mg daily, is effective for improving refractory erythema of rosacea, defined as rosacea persisting despite at least 3 months of currently accepted therapy. The individual symptoms of flushing and burning sensation significantly improved but telangiectasia and overall lesion counts did not.
Randomized controlled trial (double-blinded)
Paroxetine has been demonstrated to alleviate menopausal hot flashes due to vascular dilation and constriction, thus the hope for a similar benefit in adults with refractory erythema of rosacea. These investigators recruited adults, aged 18 to 65 years, with refractory erythema, defined as rosacea erythema persisting despite at least 3 months of currently accepted therapy (e.g., oral doxycycline). Eligible patients (N = 112) stopped their prior rosacea therapy at least 2 weeks prior to enrollment. Patients randomly received paroxetine (25 mg daily) or matched placebo. Individuals masked to treatment group assignment assessed outcomes using the Clinical Erythema Assessment (CEA) score (where 0 means clear; 1, almost clear; 2, mild; 3, moderate; and 4, severe) with success defined as a CEA score of 0 or 1 or at least a 2-grade improvement. Complete follow-up occurred for 87% of patients at 12 weeks, including 4 patients in the paroxetine group and 3 in the placebo group who discontinued therapy because of unsatisfactory outcomes.
Using per-protocol analysis, significantly more patients achieved CEA success in the paroxetine group versus the placebo group (42.9% vs 20.8%, respectively; number needed to treat = 5.7; 95% CI 3.0 - 93.2). In secondary analyses of individual outcomes, patients in the paroxetine group reported significantly increased improvement in flushing and burning sensation compared with those in the placebo group (44.9% vs 25% and 46.9% vs 18.8%, respectively). However, no significant group differences occurred in the lesion counts, telangiectasia, or rosacea quality-of-life score.
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Professor of Family Medicine, UNC Chapel Hill