The reasons for withdrawals in the first RCT18 are not clear. Numbers were similar in both groups (6/25 (24%) for the azelaic acid, tretinoin and sunscreen group versus 7/25 (28%) for the azelaic acid and sunscreen group; RR 0-9, CI 0-3-2-2).
In the second RCT29 the azelaic acid group experienced significantly more burning and peeling. There were two withdrawals in azelaic acid group and four in the hydroquinone group. However, these were described as not being due to side-effects of the preparations.
All participants in the third RCT comparing a combination of hydroquinone and glycolic acid followed by sunblock with or without 2% kojic acid,30 complained of redness, stinging and mild exfoliation in both sides of their face (randomisation was done for the side receiving each treatment). Three women withdrew from the study because of adverse effects on both sides of their face and were replaced by three other women.
In the fourth RCT comparing alpha hydroxyacid, polypeptide ascorbate complex and titanium oxide photoprotector with a preparation containing titanium oxide photoprotector,31 one woman withdrew after 28 days because of depigmentation. However, no detail is provided on whether this happened on the intervention or control cheek. A second participant was excluded when it became apparent that she did not have melasma. In the active treatment group a higher frequency of erythema and burning feeling was reported and this persisted throughout follow up. However, no further details are provided.
In the fifth RCT32 both treatments were described as being well tolerated, although all participants had some degree of skin irritation. Kojic acid gel was found to be a stronger irritant. No further detail was provided.
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Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.