From the Guidelines
Rosacea is a chronic relapsing facial skin disease characterized by recurrent flushing, erythema, inflammatory lesions, phymas, and telangiectasias, affecting an estimated 16 million people in the USA, with a significant impact on social and professional settings. According to the most recent study, 1, rosacea presents with various features, including recurrent flushing, erythema, inflammatory lesions (papules and pustules), phymas, and telangiectasias. Some key points about rosacea include:
- It is a chronic condition that can have a significant impact on a person's quality of life, particularly in social and professional settings, as evident from a global perception survey, which found that individuals with central facial redness were judged more negatively than those without 1.
- The condition can be managed through long-term avoidance of common triggers, use of gentle skin care, and adherence to pharmacologic treatment, with phenotype-based medical management being a recommended approach, as proposed by Del Rosso et al. in 2013 and recently endorsed by Schaller et al. in 2020 from the global Rosacea Consensus (ROSCO) panel 1.
- Treatment options include topical therapy, such as encapsulated benzoyl peroxide 5% (E-BPO 5%), which is a newer topical agent for rosacea, approved by the US Food and Drug Administration (FDA) in 2022, and minocycline foam, which was FDA approved for rosacea in 2020, as well as systemic agents for more severely affected patients 1. The exact cause of rosacea is still not fully understood, but it is believed to result from a combination of genetic predisposition, immune system abnormalities, and environmental factors that cause blood vessel dysfunction and inflammation in the skin. Management of rosacea involves a tailored approach, taking into account the individual's specific signs and symptoms, and may include lifestyle modifications, such as avoiding triggers, using gentle skincare products, and protecting the skin from the sun, as well as pharmacologic treatment, with the goal of reducing symptoms and improving quality of life.
From the Research
Definition of Rosacea
- Rosacea is a common chronic skin condition affecting the face, characterized by flushing, redness, pimples, pustules, and dilated blood vessels 2.
- It is a multiphasic disease associated with flushing, erythrosis, papulopustular rosacea, and phymas, each phase likely having its own treatment 3.
- The exact etiology of rosacea is unknown, but a diagnosis is made based on the updated 2017 National Rosacea Society Expert Committee guidelines, including fixed erythema, phymatous changes, papules, pustules, telangiectasia, and flushing 4.
Symptoms and Subtypes
- Rosacea can cause a range of symptoms, including flushing, erythema, papules, pustules, telangiectasia, and phymas 2, 3.
- The condition can be divided into subtypes, including erythematotelangiectatic rosacea, papulopustular rosacea, phymatous rosacea, and ocular rosacea 5.
- Identification of subtypes can help guide treatment strategies 5.
Treatment Options
- A range of treatment options are available for rosacea, including topical and oral medications, such as metronidazole, azelaic acid, and doxycycline 6, 2, 3, 5.
- Topical treatments, such as ivermectin, metronidazole, and azelaic acid, can be effective for papules and pustules 5, 4.
- Systemic treatments, such as low-dose doxycycline and isotretinoin, can be used for papules and pustules, while nonselective beta blockers can be used for flushing 4.
- Lifestyle modifications, such as daily use of sunscreen, moisturizers, and mild skin cleansers, and avoidance of triggers, are essential aspects of maintenance treatment 4.