Promising results for paroxetine in rosacea

Paroxetine appeared to be an efficacious and safe therapy for patients suffering from moderate-to-severe erythema of rosacea in a first randomised controlled trial. Further studies looking at the long-term efficacy and in-depth mechanisms of this agent are ongoing.

“Paroxetine is a selective serotonin reuptake inhibitor that decreases menopausal hot flashes,” said Dr Yingxue Huang (Central South University, China) [1]. “Since the treatment options for flushing in rosacea are limited, we aimed to evaluate the effect of paroxetine for this condition.” Dr Huang added that similar psychotropic drugs have been reported to alleviate the symptoms of rosacea, but that these effects have not yet been tested in larger studies. Therefore, the PRRERCT trial randomised 112 participants with rosacea with refractory erythema 1:1 to a daily dose of 25 mg paroxetine or a placebo. The primary endpoint was achieving success at the Clinician Erythema Assessment (CEA), defined as an improvement of at least 2 grades or a score of 0 or 1 after 12 weeks of treatment.

After 12 weeks, participants receiving paroxetine were significantly more likely to reach CEA success than participants on placebo (42.9% vs 20.8%; P=0.02). In addition, a greater proportion of participants in the experimental arm achieved flushing success (44.9% vs 25.0%; P=0.04) or an improvement in burning sensation (46.9% vs 18.8%; P=0.003).

Regarding safety, the rate of treatment-emergent adverse events was 24.1% in the paroxetine arm and 11.1% in the placebo arm. The most common treatment-emergent adverse events in the experimental arm were dizziness (10.3%), lethargy (10.3%), and nausea (8.6%).

“The regulation mechanisms of serotonin intake may explain the effectiveness of paroxetine for the treatment of rosacea ‘redness,’ since serotonin uptake plays an important role in vasomotor balance,” explained Dr Huang. “The results of the current trial indicate that paroxetine may be an effective and well-tolerated alternative treatment for patients with moderate-to-severe erythema of rosacea.” Further studies assessing the long-term efficacy and in-depth mechanism of this agent in rosacea are ongoing.

1. Huang Y, et al. Paroxetine is an effective treatment for refractory erythema of rosacea: primary results from the PRRERCT (prospective rosacea refractory erythema randomized controlled trial). Session Acne, Hidradenitis Suppurativa, Rosacea 1, WCD 2023, 3–8 July, Singapore, Singapore.