Patient case (clinical description): A 41-year-old woman comes to the dermatology clinic complaining of facial redness, especially on her forehead and cheeks. She noticed that the redness gets worse in the summer and after sun exposure. She is otherwise healthy. On physical examination, she has multiple papules and pustules present on her forehead, cheeks, and nose on a background of erythema and telangiectasias. There are no other lesions or nodules. The patient is married and has 2 children who are 5 and 9 years old. She has IUD and doesn't wish to have more kids. She does not smoke or drink alcohol. Her vital signs are normal, and BMI is 21.

Patient's own account: I'm 41, married with 2 lovely kids who are 5 and 9 years old. I have an IUD and I don't want to have more kids. I don't smoke or drink alcohol. I had to go to the dermatology clinic because I had terrible redness on my face, especially on my forehead and cheeks. It got worse in the summer and after being under the sun. I'm usually healthy. They conducted a physical exam and they found several lesions and pustules on my forehead, cheeks and nose and they also found some signs of erythema and telangiectasia. My vitals were normal, and my BMI is 21.

Clinical trial: A Study to Evaluate Safety and Equivalence of Generic Azelaic Acid Foam and Finacea® Foam in Participants With Rosacea

Eligibility criteria:
Inclusion Criteria:

          -  Participants had to be willing and able to provide written informed consent for the
             study

          -  Healthy males or non-pregnant females ≥18 years-of-age with a clinical diagnosis of
             moderate facial rosacea

          -  Participants had to have at least 8 and not more than 50 inflammatory facial lesions
             (that is, papules/pustules) and ≤2 nodules on the face. For the purposes of study
             treatment and evaluation, these lesions were limited to the facial treatment area
             including those present on the nose. Lesions involving the eyes and scalp were
             excluded from the count.

          -  Participants had to have persistent erythema on the face with moderate (3) score

          -  Participants had to have a mild (1) to moderate (2) score for telangiectasia on the
             face

          -  Participants had to have a definite clinical diagnosis of moderate facial rosacea
             (severity score 3)

          -  Participants had to be willing to minimize external factors that might trigger rosacea
             flare-ups (for example, spicy foods, thermally hot foods and drinks, hot environments,
             prolonged sun exposure, strong winds, and alcoholic beverages) during the course of
             the study

          -  Participants had to be in general good health and free from any clinically significant
             disease other than rosacea on the face, that could have interfered with the study
             evaluations

          -  Participants had to be willing and able to understand and comply with the requirements
             of the study, apply the medication as instructed, return for the required treatment
             period visits, comply with therapy prohibitions, and able to complete the study

          -  Male participants and female participants of childbearing potential had to use
             accepted methods of birth control or had to agree to practice abstinence, from study
             start to 30 days after the last administration of study drug. All female participants
             were considered to be of childbearing potential unless they had been surgically
             sterilized (hysterectomy, bilateral oophorectomy, or tubal ligation) or had been
             postmenopausal for at least a year. Any of the following methods of birth control were
             acceptable: oral contraceptives, contraceptive patches/implants (for example,
             Norplant®), vaginal ring (NuvaRing®), Depo-Provera® (Medroxy progesterone acetate),
             double barrier methods (for example, condom and spermicide), or intrauterine device

          -  Female participants of child bearing potential had to have a negative urine pregnancy
             test at baseline

          -  Participants who used make-up had to have used the same brands/types of make-up for a
             minimum period of 14 days prior to study entry and had to agree to use the same
             make-up, brand/type, or frequency of use, throughout the study

        Exclusion Criteria:

          -  Pregnant or lactating or planning to become pregnant during the study period

          -  Presence of any skin condition on the face that could have interfered with the
             diagnosis or assessment of rosacea

          -  Excessive facial hair (for example, beards, sideburns, moustaches) that would
             interfere could have interfered with diagnosis or assessment of rosacea

          -  History of hypersensitivity or allergy to azelaic acid, propylene glycol, or any other
             component of the formulation

          -  The use within 6 months prior to baseline of oral retinoids (for example, Accutane®)
             or therapeutic Vitamin A supplements of greater than 10,000 units/day (multivitamins
             were allowed)

          -  The use of estrogens or oral contraceptives for less than 3 months prior to baseline

          -  The use within 1 month prior to baseline of the following:

               -  topical retinoids to the face

               -  systemic antibiotics known to have an impact on the severity of facial rosacea
                  (for example, containing tetracycline and its derivatives, erythromycin and its
                  derivatives, sulfamethoxazole, or trimethoprim)

               -  systemic corticosteroids

          -  Use within two weeks prior to baseline of the following:

               -  topical corticosteroids

               -  topical antibiotics

               -  topical medications for rosacea (for example, metronidazole, azelaic acid)

          -  Antipruritics, including antihistamines, within 24 hours of any study visit

          -  Participants with moderate or severe rhinophyma, dense telangiectasia (score 3,
             severe), or plaque-like facial edema

          -  Participants with a severe irritation grade for erythema, dryness, scaling, pruritus,
             stinging/burning, and edema

          -  Ocular rosacea (for example, conjunctivitis, blepharitis, or keratitis) of sufficient
             severity to require topical or systemic antibiotics

          -  A participant who had used a sauna during the 2 weeks prior to study entry and during
             the study

          -  Participants who had performed wax epilation of the face within 14 days prior to
             baseline

          -  A participant who had a history of being unresponsive to topical azelaic acid therapy

          -  A participant who had any clinically significant condition or situation, other than
             the condition being studied that, in the opinion of the Investigator, could have
             interfered with the study evaluations or optimal participation in the study

          -  A participant who had used any topical azelaic acid therapy within 30 days of baseline
             visit

          -  Participants who had participated in an investigational drug study (for example,
             participants had been treated with an investigational drug) within 30 days prior to
             baseline were excluded from study participation. Participants who were participating
             in non-treatment studies such as observational studies or registry studies could be
             considered for inclusion

          -  Participants who had been previously randomized in this study

          -  Participants who had laser therapy (for telangiectasia or other conditions) and
             phototherapy to the facial area within 180 days prior to study entry

          -  Participants who had cosmetic procedures (for example, facials), which could affect
             the efficacy and safety profile of the investigational product within 14 days prior to
             study entry

          -  Employees or staff of the research site were excluded from participation in the study

          -  No more than 1 participant from the same household was allowed to participate in the
             study
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 18 Years old.


Eligibility (NLI label): Entailment