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Summary   Background  Papulopustular rosacea is characterized by chronic facial erythema and inflammatory facial lesions. Minocycline has anti‐inflammatory properties which may be effective in the treatment of rosacea inflammatory lesions.    Objectives  To assess the safety and efficacy of once‐daily topical minocycline gel 1% and 3% in patients with papulopustular rosacea.    Methods  This was a prospective, 12‐week, double‐blinded study conducted at 26 sites in the United States; 270 patients with papulopustular rosacea and 12–40 inflammatory lesions were randomized to minocycline 1%, minocycline 3% or vehicle. The primary endpoint was the mean change in inflammatory lesions at week 12. Key secondary endpoints included success on an Investigator's Global Assessment ( IGA ).    Results  Baseline mean lesion counts were 24·6, 25·1 and 24·3 in the minocycline 1%, minocycline 3% and vehicle groups, respectively; at week 12, the counts had decreased by 12·6, 13·1 and 7·9, respectively. Minocycline significantly decreased lesions, compared with the vehicle [ P  = 0·01, 95% confidence interval ( CI ) 7·9 to 0·9, for minocycline 1%;  P  = 0·007, 95%  CI  8·3 to 1·3, for minocycline 3%]. The proportion of patients achieving  IGA  success was 39% in the minocycline 1% arm [ P  = 0·34, odds ratio ( OR ) 1·396 and  OR  95%  CI  0·71 to 2·75 vs. vehicle], 46% in the minocycline 3% arm ( P  = 0·04,  OR  2·03 and  OR  95%  CI  1·04 to 3·95 vs. vehicle) and 31% in the vehicle arm.    Conclusions  Minocycline topical gel appears to be safe and tolerable at concentrations of 1% and 3%, and both concentrations significantly decreased inflammatory lesion counts, with a significantly larger proportion of patients achieving  IGA  success at week 12 in the minocycline 3% arm. These findings support further evaluation of minocycline gel for treating inflammatory lesions associated with papulopustular rosacea.   Linked Comment:   Hampton.  Br J Dermatol  2020;  183 :412–413.

british journal of dermatology

A multicentre, randomized, double‐masked, parallel group, vehicle‐controlled phase IIb study to evaluate the safety and efficacy of 1% and 3% topical minocycline gel in patients with papulopustular rosacea