From the Guidelines
Rosacea is a chronic inflammatory skin condition that primarily affects the face, causing redness, visible blood vessels, small red bumps, and sometimes eye irritation, and its treatment depends on the type and severity of symptoms, with the most recent and highest quality study 1 suggesting that microencapsulated benzoyl peroxide 5% (E-BPO 5%) is a valuable treatment option for managing inflammatory lesions of rosacea.
Description of Rosacea
Rosacea is a chronic relapsing facial skin disease that presents with one or more of the following features: recurrent flushing, erythema, inflammatory lesions (papules and pustules), phymas, and telangiectasias, as described in the study 1. It is estimated that 16 million people in the USA have rosacea, with many more undiagnosed cases, especially in skin of color.
Treatment of Rosacea
Treatment of rosacea depends on the type and severity of symptoms. For mild rosacea, gentle skincare with non-irritating cleansers and daily broad-spectrum sunscreen is essential. Prescription treatments include topical medications like metronidazole (0.75% or 1% applied once or twice daily), azelaic acid (15-20% applied twice daily), or ivermectin 1% cream (applied once daily), as recommended in the study 1. For more severe cases, oral antibiotics such as doxycycline (40-100mg daily for 8-12 weeks) may be prescribed, with the study 1 showing that once-daily doxycycline 40 mg is effective in reducing inflammatory lesions.
Lifestyle Modifications
Lifestyle modifications are crucial in the management of rosacea, including avoiding triggers like spicy foods, alcohol, extreme temperatures, and harsh skincare products, as suggested in the study 1. General skincare and eye care underlie the treatment approach to managing cutaneous and ocular features, respectively.
Recent Developments
The most recent study 1 suggests that microencapsulated benzoyl peroxide 5% (E-BPO 5%) is a valuable treatment option for managing inflammatory lesions of rosacea, with a rapid onset of action, demonstrated efficacy by Week 2, excellent tolerability, and sustained long-term results for up to 52 weeks of treatment. The use of E-BPO 5% offers a promising addition to the treatment options for rosacea, and its microencapsulation technology prolongs drug delivery time, aiming to improve therapeutic response while minimizing skin irritation.
From the Research
Description of Rosacea
- Rosacea is a chronic cutaneous disorder that primarily affects the face, characterized by erythema, telangiectasia, and inflammatory lesions including papulo-pustules and swelling 2.
- The essential component of the disease is the persistent erythema of facial skin, with episodes of flushing being common 2.
- Rosacea can lead to swelling and erythema of the nose, along with dilatation of the pilosebaceous poral orifices, known as rhinophyma, in chronic cases 2.
Prevalence of Rosacea
- Rosacea affects up to 10% of the world population, especially fair-skinned individuals aged 35-50 2.
- Women are affected more often than men 2.
Treatment of Rosacea
- Several treatment modalities are available, including topical medications, systemic drugs, lasers, and light-based therapies 2, 3.
- Topical medications such as azelaic acid, metronidazole, and sulfacetamide/sulfur are commonly used 2, 3.
- Oral antibiotics such as tetracyclines and oral retinoids are also used, alone or in combination 2, 3.
- Light therapies such as intense pulsed light and pulsed dye laser are best used for the erythemato-telangiectatic type 2.
- New additions to the therapeutic armamentarium include topical brimonidine, oxymetazoline, ivermectin, tacrolimus, pimecrolimus, and botulinum toxin 2.
Treatment Approaches
- Treatment starts with avoidance of triggers and use of mild cleansing agents and moisturizing regimens, as well as photoprotection with wide-brimmed hats and broad-spectrum sunscreens 4.
- For inflammatory lesions and erythema, the recommended initial treatments are topical metronidazole or azelaic acid 4.
- Papulopustular rosacea can be treated with systemic therapy including tetracyclines, most commonly subantimicrobial-dose doxycycline 4.
- Phymatous rosacea is treated primarily with laser or light-based therapies 4.
- Ocular rosacea is managed with lid hygiene, topical cyclosporine, and topical or systemic antibiotics 4.