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The following is a summary of “Efficacy and safety of topical minocycline preparations for papulopustular rosacea: a systematic review and meta-analysis,” published in the April 2025 issue of Frontiers in Medicine by Alamri et al. 

Rosacea, a chronic inflammatory skin condition, with papulopustular rosacea (PPR) presented with papules and pustules, and topical minocycline allowed for high local medication concentrations with decreased systemic exposure and fewer side effects. 

Researchers conducted a retrospective study to assess the efficacy and safety of topical minocycline preparations in treating moderate to severe PPR.  

They included randomized clinical trials (RCTs) comparing the effectiveness and safety of 1.5% minocycline foam and 1% or 3% minocycline gel vs placebo in individuals with moderate to severe PPR. A systematic search was performed in Medline, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and ClinicalTrials.gov. Efficacy outcomes were absolute and percentage changes in inflammatory lesion counts, the proportion achieving at least a 2-grade improvement in Investigator Global Assessment (IGA), and those attaining an IGA 0/1 score (“clear” or “almost clear”). The study followed PRISMA guidelines and was registered in PROSPERO (CRD42023447486). Study quality was assessed using the ROB-2 tool, and evidence levels were evaluated with GRADE. Data analysis was conducted using RevMan.  

The results showed that 5 RCTs with a low risk of bias included 2,453 enrolled participants. Minocycline (FMX103) 1.5% foam demonstrated significant treatment success based on the IGA score [Risk Ratio (RR) = 1.31, 95% confidence interval (CI) = 1.04–1.66, P = 0.02], FMX103 and minocycline gel 1% and 3% reduced inflammatory lesion counts (RR = 3.49, 95% CI = 2.61–4.36, P < 0.00001). Minocycline 1.5% foam significantly decreased inflammatory lesion counts from baseline (RR = 9.45, 95% CI = 5.84–13.06, P < 0.00001). Other symptom reduction measures were not statistically significant for both foam and gel formulations.  

Investigators concluded that topical minocycline preparations provided statistically reductions in inflammatory lesions and improved IGA treatment success in moderate to severe PPR. 

Source: frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1517825/full