Permethrin 5% Cream versus Metronidazole 0.75% Gel for the Treatment of Papulopustular Rosacea

<i>Background:</i> Permethrin 5% cream used against human ectoparasites suggests that it may be effective in papulopustular rosacea. <i>Methods:</i> This study included 63 patients diagnosed as having papulopustular rosacea based on the clinical and histological findings. Patients were randomly assigned into permethrin (n = 23), metronidazole (n = 20) and placebo (n = 20) groups. Scores of erythema, telangiectasia, edema and rhinophyma and the numbers of papules, pustules, inflammatory nodules and <i>Demodex folliculorum</i> were determined. Twenty-three patients were given permethrin 5% cream (Zalvor 5% skin cream^®), 20 patients metronidazole 0.75% gel (Roza gel^®) and 20 patients placebo cream (Basis cream^®), in packages looking identical to those of metronidazole and permethrin creams, and were recommended to apply them to their faces twice a day. All patients were also given SPF 20 cream for protection against sunlight. Two months of treatment were planned, and the patients were invited to the clinic for fortnightly controls. Scores of erythema, telangiectasia, edema and rhinophyma and the numbers of papules, pustules, inflammatory nodules and <i>D. folliculorum</i> were recorded at each visit. The mean scores of erythema and the mean numbers of papules, pustules and <i>D. folliculorum</i> were determined at baseline and on days 15, 30, 45 and 60. Side effects were also detected. <i>Results:</i> The effect of permethrin 5% cream on <i>D. folliculorum</i> was superior to that of metronidazole 0.75% gel. The effect of permethrin 5% cream on erythema and papules was found to be more effective than placebo and as effective as metronidazole 0.75% gel. However, it had no effect on telangiectasia, rhinophyma and pustules. <i>Conclusion:</i> It can be concluded that the application of permethrin 5% cream twice daily for 2 months can be as effective and reliable as metronidazole in the treatment of rosacea and a greater benefit can be gained when it is combined with other systemic and/or topical treatments.