There are a large number of FDA approved topical drugs that are useful for treating various types of inflammatory dermatological conditions but which are not steroids, NSAIDs, or immunomodulators. One well-known example of this class is the antibacterial/anti – protozoal drug, metronidazole, which is used to treat rosacea, a skin disease that affects 14 million Americans (59,60). Rosacea is sometimes characterized mistakenly as adult-acne because patients present with a reddened face and acne-like symptoms. Individuals with this disease experience redness, pain, and itching on the face, chest, back, and as the disease progresses small blood vessels and small papules appear. Severe rosacea involves the ocular area and causes disfigurement to the nose, termed, rhinophyma. The causes of rosacea are not known, although there appears to be some genetic predisposition for the disease. Metronidazole (sold under the trade name Metrogel®) has been shown to be effective in alleviating some of these symptoms and, although the mechanism of action is unknown, efficacy is not thought to be related solely to its antimicrobial activity. Rosacea is also treated with the oral antibiotic tetracycline, but again, the mechanism of action is not known. Other topical non-steroidal, non-NSAID treatments for rosacea include azaleic acid, sodium sulfacetamide, and Accutane (61). While somewhat effective none of these products resolve all of the redness and other symptoms of rosacea.
Other non-steroidal, non-NSAID topical products used to treat inflammatory conditions such as eczema, psoriasis, and seborrheic dermatitis include coal tar, tazarotene (a retinoid derivative), anthralin, and even the simple OTC keratolyic compound, salicylic acid. However, for most inflammatory conditions the most effective treatments are still the corticosteroids, the immune modulators and recently the “biologics.”