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Treatment of rosacea and demodicosis with benzyl benzoate: effects of different doses on Demodex density and clinical symptoms.

J Eur Acad Dermatol Venereol. 2019 Sep 07;:

Authors: Forton FMN, De Maertelaer V

Abstract
BACKGROUND: Patients with rosacea or demodicosis have high facial skin Demodex densities (Dds). Topical ivermectin, benzyl benzoate (BB) and crotamiton have been shown to decrease Dds in vivo, but there are few data on the clinical and acaricidal effects of BB among patients with rosacea.
OBJECTIVE: To evaluate the impact of topical BB (+crotamiton) treatment on Dds and clinical symptoms of rosacea and demodicosis, and compare three BB treatment regimens.
METHODS: In this retrospective observational study, 394 patients (117 with rosacea, 277 with demodicosis) were included. Three BB (+crotamiton) treatment regimens were compared: 12% once daily, 12% twice daily and 20% once daily. Dds were measured using two consecutive standardized skin surface biopsies (superficial [SSSB1] and deep [SSSB2]) before treatment and at the first follow-up. Symptoms were evaluated using investigator global assessment. Treatment was considered effective if the Dd had normalized (SSSB1 ≤5 D/cm2 AND SSSB2 ≤10 D/cm2 ) or symptoms had cleared and curative if the Dd had normalized and symptoms had cleared.
RESULTS: At an average of 2.7 months after treatment start, the total Dd (SSSB1+2) had decreased by 72.4±2.6% from the initial value across the whole cohort. Dds had normalized in 139 patients (35%) and symptoms had cleared in 122 (31%). Treatment was effective in 183 (46%) patients and curative in 78 (20%). Compliance was good: 77% of patients correctly followed treatment instructions. Results were similar in patients with rosacea and those with demodicosis. The 12% once daily regimen was less effective than the other doses, and had poorer compliance than the 12% twice daily regimen.
CONCLUSION: Topical treatment with BB (+crotamiton) may be an effective treatment for rosacea as well as demodicosis, indirectly supporting a key role of the mite in the pathophysiology of rosacea. The two higher dose regimens were more effective than the lower dose.

PMID: 31494991 [PubMed - as supplied by publisher]

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