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Emrosi Now Available For The Treatment Of Rosacea
Emrosi™ (minocycline hydrochloride extended-release capsules) is now available for the treatment of inflammatory lesions (papules and pustules) of rosacea in adults.
Emrosi, a tetracycline-class drug, is supplied as an extended-release capsule containing 40mg of minocycline (equivalent to 43.19mg of minocycline hydrochloride) as 10mg immediate-release and 30mg extended-release beads.
The approval of Emrosi was supported by data from 2 randomized, double-blind, active- and placebo-controlled phase 3 trials (ClinicalTrials.Gov Identifier: MVOR-1 [NCT05296629], MVOR-2 [NCT05343455]) that included adults with moderate to severe papulopustular rosacea (N=653).
In both trials, treatment with Emrosi was associated with significant improvement of rosacea compared with doxycycline 40mg and placebo, based on the proportion of patients who achieved Investigator's Global Assessment (IGA) treatment success (defined as IGA score of grade 0 [clear] or 1 [near clear] with at least a 2-grade reduction from baseline), and the absolute change from baseline in total inflammatory lesion counts. The most common adverse reaction reported in clinical trials was dyspepsia.
The recommended dosage of Emrosi is 1 capsule taken orally once daily. The medication can be taken with or without food, though ingestion of food along with Emrosi may help reduce the risk of esophageal irritation and ulceration.
Commenting on the launch, Claude Maraoui, Co-Founder, President and Chief Executive Officer of Journey Medical, said, "Rosacea is a challenging condition that affects millions, and Emrosi, the lowest-dose oral minocycline on the market, delivers significantly superior clinical outcomes for rosacea compared to Oracea® and placebo, while maintaining a comparable safety profile, as demonstrated in clinical trials."
According to the Company, Emrosi is available by prescription at specialty pharmacy chains.
Journey Slips On FDA Approval Of Rosacea Therapy
News
Wikimedia
Rosacea case showing redness and inflammatory papules and pustules
Journey Medical has claimed FDA approval for its Emrosi therapy for rosacea, which it thinks could become a "standard of care" drug for the common skin disorder.
The new capsule formulation of the antibiotic minocycline hydrochloride has been cleared by the US regulator to treat the inflammatory lesions caused by rosacea – which causes flushing or long-term redness and pustules on the face – in adults.
Rosacea is estimated to affect around 16 million people in the US, said Journey's chief executive, Claude Maraoui, on an investor call held after the approval was announced, adding that Emrosi is the first new oral treatment for the condition since Galderma's Oracea (doxycycline) was launched in 2006.
Maraoui said Emrosi offers a "unique treatment option" for patients and will be launched in the first or second quarter of 2025, once manufacturing capacity has been scaled up.
Investors seemed less confident in the new drug's prospects, however, as shares in Journey fell nearly 14% after the announcement, apparently over concern about the label approved by the FDA, and slid another 6% after hours.
Specifically, there are concerns about the lack of a claim on the reduction of redness (erythema) with Emrosi, which Journey had been hoping for and would differentiate it from Oracea, which is also only approved for the treatment of inflammatory lesions in rosacea, but has become the standard treatment in the US.
Another consideration is that the first generic versions of Oracea have now launched into the US market, which could introduce downward pricing pressure.
Maraoui shrugged off those concerns, telling analysts that Emrosi "has potential to transform our dermatology business, given its anticipated strong competitive position and our existing commercial organisation," which already sells several brands including acne therapies Accutane (isotretinoin), Amzeeq (minocycline), and Targadox (doxycycline), and topical rosacea therapy Zilxi (minocycline).
The company - which recorded sales of just under $15 million in the second quarter of this year - has previously suggested that Emrosi could become a $300 million-a-year product if FDA-approved. It has not yet revealed its pricing plans for the drug but, according to Maraoui, would be in the same ballpark as the $950 per month cost of Oracea.
Journey acquired joint development and commercial rights to Emrosi (formerly DFD-29) in the US and Europe from India's Dr Reddy's Laboratories in 2021, on the back of phase 2 data. It ran a pair of phase 3 trials that showed a superior effect on Investigator's Global Assessment, as well as the reduction in total inflammatory lesion count compared to Oracea and placebo.
Image by Michael Sand, Daniel Sand, Christina Thrandorf, Volker Paech, Peter Altmeyer, Falk G Bechara via Wikimedia
The Best Products For Rosacea And Redness, According To Dermatologists
If you frequently experience facial redness, irritation and small bumps, you may have rosacea. According to the American Academy of Dermatology, rosacea impacts more than 14 million people in the U.S. Alone, and usually affects those between the ages of 30 and 50 years old. And since there's no cure, many are left with the difficult task of treating their own flare-ups.
I have written about expert-backed solutions to common skin care concerns for over four years and suffer from moderate rosacea myself. I spoke to dermatologists about common triggers of rosacea flare-ups and how to avoid them, plus the best skin care ingredients to help tame redness and inflammation. I compiled our experts' recommendations for the best cleansers, sunscreens, moisturizers and more to consider for rosacea, as well as NBC Select staff favorites.
SKIP AHEAD How I picked the best products for rosaceaBest products for rosaceaWhy trust NBC Select?
When shopping for rosacea treatments, dermatologists recommend considering the following key factors:
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Below, I compiled expert-recommended moisturizers, facial cleansers, serums, sunscreens and more to help tame redness and irritation from rosacea. I also included products I and other rosacea-prone NBC Select editors use to reduce flare-ups.
Best overall moisturizer: La Roche-Posay Toleriane Double Repair Face Moisturizer$23.99
Amazon
$24.99
Ulta
What we like
Something to note
La Roche-Posay is an expert-recommended brand for people dealing with rosacea or acne-prone skin (or both). I use this moisturizer every night before bed since it's both gentle on my rosacea and hydrating enough to keep my flaky, dry skin at bay. The moisturizer has ceramides and niacinamide, both of which can help soothe and calm rosacea flare-ups, says Dr. Erum Ilyas, a board-certified dermatologist at Schweiger Dermatology. I pair this moisturizer with the brand's Toleriane Hydrating Gentle Cleanser, which is a gel face wash that maintains my skin's moisture and doesn't irritate it (unlike most other cleansers).
Best foaming cleanser: Aveeno Calm + Restore Redness Foaming Cleanser$9.97
$14.69
Amazon
$10.49
Target
$12.99
Walgreens
What we like
Foaming agents can often be too harsh on rosacea-prone skin because they remove most of the oil on the face, which can lead to even more dryness and flaking, experts say. However, there are a few that can be safe for sensitive, rosacea-prone skin, including this one from Aveeno. "It recognizes that by adding calming and hydrating ingredients to balance the foam of the cleanser, those that need their cleanser to foam in order to feel clean can [use it] while limiting the risk of excess dryness," says Ilyas.
Best for redness: Clinique Redness Solutions Daily Relief Cream$65.00
Amazon
$65.00
Clinique
What we like
Clinique's Redness Solutions product line includes cleansers, moisturizers and sunscreens that can benefit those prone to redness and rosacea. Though the products typically look green when you initially apply them, experts say the green hue goes away when you blend it into the skin. In fact, the green particles work to camouflage the red color, according to the dermatologists I spoke to. The Clinique Daily Relief Cream is a great option if your skin has blotchy red spots: Not only does the cream reduce the appearance of redness, but it also gently calms irritated skin, according to Clinique.
Best overall cleanser: Vanicream Gentle Facial Cleanser$8.86
Walmart
$12.99
Ulta
What we like
Something to note
For people with very sensitive skin (especially those who might feel a burning or stinging sensation when trying new products, which is common with rosacea), experts recommend Vanicream. This cleanser has the National Eczema Association's Seal of Acceptance — the program evaluates products based on the NEA's criteria of ingredients and contents to ensure they're beneficial for people with sensitive skin. The dermatologists I spoke to also recommend the brand's moisturizing cream for very dry, sensitive skin, which is also one of our favorite moisturizers for dry skin.
Best overall sunscreen: EltaMD UV Clear Sunscreen with SPF 46$44.00
Amazon
$44.00
Elta Md
$44.00
Dermstore
What we like
Something to note
The EltaMD UV Clear Sunscreen is a favorite among experts and NBC Select staff because it's free of heavy moisturizers that can clog pores, plus has niacinamide, which acts as a natural anti-inflammatory ingredient that tames rosacea. It's the only sunscreen I've tried that doesn't flare up my rosacea and soothes any blotchy redness on my face. Similarly, former NBC Select managing editor Leah Ginsberg uses it on her fair, sensitive skin every day following her dermatologist's recommendation because it doesn't cause flare-ups for her, either. "I [also] love the texture and it never burns my eyes if I sweat," she says. The mineral-based sunscreen has zinc oxide, an ingredient that's better suited for sensitive skin compared to chemical filters, experts say.
Best for mature skin: Senté Dermal Repair Cream$164.00
Amazon
$164.00
Dermstore
$164.00
Sente Labs
What we like
This Senté cream has heparan sulfate analog, an ingredient that mimics the naturally-occurring molecule heparan sulfate, which reduces redness and hydrates the skin. This cream is a favorite of Ginsberg: "I have mature skin, and rosacea can complicate finding skin care to help with fine lines because sometimes active ingredients can cause a flare-up," she says. Her dermatologist recommended the Senté Dermal Repair Cream, which she says noticeably soothes her rosacea-prone skin. "It's on the thicker side, so it really moisturizes, but it feels light on my skin and absorbs well. It is on the expensive side, but it's worth it."
Best budget-friendly cleanser: Cetaphil Gentle Skin Cleanser$13.44
$15.49
Amazon
$11.97
Walmart
$17.49
Ulta
What we like
Something to note
Cetaphil's Gentle Skin Cleanser is an NBC Select Wellness Awards winner and comes recommended by dermatologists thanks to its gentle, non-foaming formula that hydrates and soothes rosacea-prone skin. Ginsberg says she's used this cleanser since she was 16 years old and loves that it's both affordable and gentle on her skin. "It's also great for travel because you don't have to rinse it off with water — you can massage it in and then (gently) wipe it off," she says.
Best acne treatment: Differin Gel$20.81
Amazon
$23.79
CVS Pharmacy
$17.99
Walgreens
What we like
Something to note
Though retinoids can be too harsh on sensitive skin, they can still work for those who are rosacea-prone if they're introduced slowly, starting with just once a week before building up tolerance. "I find the best approach is to first create a simplified routine that directly addresses the rosacea, followed by consideration of adding retinol and retinoids once inflammation in the skin is under control," says Ilyas.
Adapalene gel, which is an OTC retinoid treatment that treats mild to moderate acne and blackheads, is considered a milder retinoid compared to other options like tretinoin and tazarotene, says Illyas. Both she and Dr. Gabriela Soza, a board-certified dermatologist at Wexler Dermatology, recommend Differin Gel (which contains 0.1% adapalene) as a suitable acne-fighting option for people with rosacea.
Best face mask: Mediheal Best Korean Sheet MaskWhat we like
NBC Select editorial projects manager Rebecca Rodriguez, who has mild rosacea and eczema, uses these Mediheal sheet masks a few times a week to calm irritation. "These are my go-to face masks when my redness is particularly bad and the results are amazing," says Rodriguez. "The mask feels cool and soothing and doesn't irritate my skin at all. Once I take it off, the redness has gone down substantially and my face feels less sensitive." These masks, which come in a pack of 10, have three types of cica, an ingredient that helps soothe irritated skin, treat acne and reduce redness, according to the brand.
Best barrier cream: Avène Cicalfate+ Restorative Protective CreamWhat we like
If you're looking to repair a damaged skin barrier, consider this Avène cream, which comes recommended by Ginsberg. "As I've gotten older, my skin has become more dull, and I refused to give up my at-home peel pads even though they're not good for my rosacea," she says. "So, I needed the most soothing barrier repair cream I could find to use after — I tried [this cream] and haven't looked back." It's extremely thick (almost like toothpaste consistency, but silkier), says Ginsberg, so she warms it up in her hands before applying it. "When I first put it on, it leaves a pretty greasy sheen, but overnight, it sinks into my skin and I wake up completely hydrated without a hint of redness," she says.
Best for sensitive skin: Cetaphil Moisturizing Cream$8.79
$10.97
Amazon
$10.97
Walmart
What we like
Much like Cetaphil's gentle skin cleanser, the brand's moisturizing cream can be a great option for those with very sensitive skin. The cream, which earned the top spot on our list of 100 best moisturizers, has a non-greasy formula with no added fragrance to avoid irritation. It can also provide up to 24 hours of hydration, according to the brand. If you're looking for a daytime moisturizer, Cetaphil's Redness Relieving Daily Facial Moisturizer has SPF 20 and a tinted formula to reduce the appearance of redness.
Best bar soap: Dove Sensitive Skin Beauty Bar$11.97
Amazon
$11.97
Walmart
What we like
One of our favorite bar soaps, Dove's Beauty Bar is a great budget-friendly cleanser for sensitive skin, says Dr. Apple Bodemer, a board-certified dermatologist and associate professor of dermatology at the University of Wisconsin School of Medicine and Public Health. The hypoallergenic formula is safe to use as both a facial cleanser and body soap, and it has mild and moisturizing ingredients like glycerin that can help maintain the skin's natural moisture barrier, says Bodemer.
Best serum: The Ordinary Azelaic Acid 10% Suspension Brightening Cream$12.20
Sephora
$12.20
Nordstrom
What we like
Ilyas recommends this serum to help improve redness and generally even out skin tone, including any dark spots caused by bumps and blemishes. The serum has 10% azelaic acid and is gentle enough to use up to twice a day, according to the brand.
Best nighttime lotion: CeraVe PM Facial Moisturizing Lotion$14.97
$19.99
Amazon
$14.99
Target
$19.99
Ulta
What we like
One of our favorite moisturizers for acne-prone skin, this Cerave nighttime lotion has ceramides that can help restore the skin barrier and soothe rosacea-prone skin, says Ilyas. You can also purchase the brand's AM Facial Moisturizing Lotion for the daytime, which has a gentle formula and SPF 30 (the minimum amount of sun protection recommended by experts).
Best acne spot treatment: Sunday Riley Saturn Sulfur + Niacinamide Spot Treatment Mask$20.00
Amazon
$20.00
Ulta
$20.00
Sephora
What we like
Sulfur is an ingredient that helps to gently even out skin tone and reduce bumps caused by rosacea, says Ilyas. She recommends this spot treatment mask from Sunday Riley, which you can apply to blemishes or textured areas of the skin. The treatment helps remove dead skin cells, draw out impurities and reduce redness, according to the brand. After letting the mask dry on the skin, the brand recommends washing it off with warm water.
Best tinted sunscreen: Isdin Eryfotona Ageless Tinted Sunscreen$78.00
Amazon
$78.00
Isdin
$78.00
Dermstore
What we like
This Isdin tinted sunscreen can cover up redness and protect the skin against the sun, which is rosacea's biggest trigger, says Soza. It also has peptides and antioxidants to also help minimize signs of fine lines and wrinkles, according to the brand.
Best serum for redness: The Inkey List Azelaic Acid Serum$18.00
Sephora
$18.00
The Inkey List
What we like
Something to note
When redness is a major concern, this azelaic acid serum, which comes recommended by Ilyas, has green-colored micro particles that can help mask redness. It also has 0.3% allantoin, which is a chemical compound that can help soothe irritation, according to the brand.
What causes rosacea?
Rosacea is best known as an inflammatory skin condition — the skin reacts to a trigger, which results in broken blood vessels and an increased sensitivity of the skin overall, says Ilyas. Unlike most people who have a baseline level of redness to their complexion, people with rosacea can experience recurrent flushing and bumps that look like acne breakouts, which can be accompanied by warmth, burning, itching and other skin sensitivities.
Though rosacea breakouts may look like adult acne, they don't behave as such: "You go to pop the 'pimple,' but they don't really come to a head [and] they just get angrier at you," says Ilyas. "This is followed by the skin starting to swell or thicken, taking on an 'orange-peel' appearance with widened patulous pores."
The location of the bumps on your face can also help you figure out whether they're regular pimples or the result of rosacea. "Hormonal acne or other forms of adult acne tend to involve more of the lower face, whereas with rosacea we see the involvement of the nose, the central part of the cheeks and the center of the forehead," says Bodemer.
Triggers for rosacea flare-ups vary from person to person, but the most common ones are sun exposure and heat, experts say. Other triggers include alcohol, spicy foods, hot beverages and chocolate.
"I like to joke with my patients that all the fun things in life can trigger rosacea," says Soza. Emotional triggers can also be a cause of rosacea for many people, according to Bodemer.
How can you best manage your rosacea?
Since there isn't a known cure for rosacea, the best way to manage it is to figure out your specific triggers and avoid them when possible. Keep a symptom diary to track when you flare-up and jot down what you did before it, including what you ate. "I see people who are very sensitive to simple carbohydrates, so when they're eating more junk food and more processed sugars they will tend to flare more," says Bodemer.
Because people with rosacea tend to have dry and flaky skin that's both sensitive and reactive, they're more likely to have certain reactions to skin care products, says Bodemer. When crafting a gentle skin care routine, it's important to first see a board-certified dermatologist who can evaluate your rosacea and come up with a treatment plan, which may include one or more prescription medications like doxycycline (an oral antibiotic) and metronidazole (a topical treatment).
What ingredients are safe for rosacea?
Below are a few gentle, hydrating ingredients experts recommend for people with rosacea and overall skin sensitivities:
You should also focus on wearing a mineral-based sunscreen with broad-spectrum SPF 30 or higher. "I cannot emphasize the importance of sun protection and sunscreen enough," says Soza. Mineral sunscreens (also called physical blockers) contain zinc oxide or titanium dioxide rather than a chemical base, so they don't absorb into the skin and can be less irritating for those prone to rosacea, she says.
What type of products should you avoid with rosacea?
Take a "less is more" approach when crafting a skin care routine for rosacea, says Ilyas. Taking a closer look at your skin care products, eliminating redundancy and choosing multitasking products can reduce the chances of using items that can potentially aggravate the skin over time, she says. That means skipping out on common skin care additions like toners (including witch hazel and alcohol-based toners that can aggravate rosacea), acne treatments, retinol and exfoliants.
Be mindful of certain acne treatments People may consider acne treatments to help with rosacea bumps, but that may only make rosacea worse, according to Ilyas. "Although people can get breakouts with rosacea, they are not the same — anyone with rosacea that has tried to 'pop' their pimples will tell you it doesn't work," she says. Avoid acne-fighting products with harsh ingredients like benzoyl peroxide and salicylic acid , which can irritate sensitive, rosacea-prone skin. Both Ilyas and Soza recommend using azelaic acid to control acne instead.
Limit your retinoid usage
Retinoids can dry out the skin and sometimes cause rosacea flare-ups, so it's best to avoid them if you have moderate to severe rosacea. However, people with mild rosacea don't necessarily have to stay away from them altogether: "You should ease into it and take it slow — start applying once a week, increasing frequency as you build tolerance," says Soza.
If you choose to use retinol or a retinoid, apply a small pea-sized amount to the full face, and use the "moisturizer sandwich technique," which means you moisturize, apply the treatment and then moisturize again, says Soza. "This will help your skin stay hydrated while still maintaining efficacy," she says.
Avoid harsh exfoliants
Exfoliating can be a key step in any weekly skin care routine, and people with rosacea may be tempted to exfoliate to help reduce the flaky dead skin caused by the condition. However, experts say you should avoid exfoliating altogether if you have rosacea.
"The more you inflame the skin [with exfoliants], the more flaking you're going to have," says Bodemer, adding that the flaking on the skin is due to the inflammation caused by rosacea. You should also avoid any products that have small beads or require scrubbing. If you're really insistent on exfoliating, simply use water and a soft washcloth, experts say.
Ilyas recommends limiting or avoiding the use of alpha hydroxy acids (AHAs) and beta hydroxy acids (BHAs), which are chemical exfoliants. "Although people with rosacea may use these for anti-aging benefits, care should be taken to avoid excess irritation — rosacea alone can make the skin sensitive and adding in chemical exfoliation can aggravate this irritation," she says.
At NBC Select, we work with experts who have specialized knowledge and authority based on relevant training and/or experience. We also take steps to ensure that all expert advice and recommendations are made independently and with no undisclosed financial conflicts of interest.
I am an updates editor at NBC Select who has written a variety of skin care stories, including treatments for cystic acne, keratosis pilaris and dark under-eye circles. For this article, I spoke to three dermatologists about how to tame rosacea and highlighted their recommendations for the best products to consider. I also included recommendations from NBC Select editors who have rosacea.
Catch up on NBC Select's in-depth coverage of tech and tools, wellness and more, and follow us on Facebook, Instagram, Twitter and TikTok to stay up to date.
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