New recommendations urging dermatologists to place greater emphasis on persistent redness in rosacea were recently published in the Journal of Drugs in Dermatology. Titled “Update on Facial Erythema in Rosacea,” the article was based on a recent NRS roundtable to discuss this key aspect of the disorder in light of its recently updated standard classification system and standard management options, new burden-of-illness study results, and significant advances in medical therapy and patient care.
“Based on current scientific knowledge and clinical experience, rosacea is now classified as a single disorder with many potential phenotypes that may occur in various combinations, with persistent facial erythema as the primary diagnostic sign,” said Dr. Richard Gallo, chair of dermatology at the University of California-San Diego, who led the roundtable. “Combined with study results showing the substantial psychological and social impact of facial erythema alone, these important findings have clarified our understanding of how and why all signs and symptoms of rosacea should be effectively managed for optimal patient outcomes.”
Research has demonstrated that rosacea’s initial redness as well as its other diverse features are likely to be part of a consistent continuum of inflammation, and medical therapies that work to reduce inflammation may be useful in treating this wide range of signs and symptoms. In addition, data collected in NRS surveys as well as in burden-of-illness studies showed that persistent redness, though sometimes dismissed by physicians as a less serious phenotype, has a significant impact on sufferers’ quality of life, often comparable to the impact of eczema, atopic dermatitis and psoriasis. In an NRS survey of 1,675 rosacea patients, 82% of those who suffered from erythema reported the condition had a negative impact on their general outlook on life, with the figure rising to 90% for those with moderate to severe redness.
There are currently two FDA approved prescription therapies specifically for the erythema from neurovascular dysregulation in rosacea, brimonidine and oxymetazoline, both alpha agonists but acting on different receptors.
Anti-inflammatory therapies may be used to reduce perilesional erythema from papules and pustules, and light devices such as pulsed dye and potassium titanyl phosphate (KTP) lasers and intense pulsed light (IPL) are well established in clinical practice as effective in removing telangiectasia and reducing erythema.
While rosacea is still treated with only one medication by some doctors, the roundtable participants agreed that treating every sign and symptom with targeted therapies in cooperation with the patients will achieve the best overall outcome, both objectively in terms of clear skin and subjectively in terms of quality of life.
In addition to designing a comprehensive treatment plan, educating the patient on compliance — emphasizing the importance of using more than one medication, as well as their proper use — is challenging but necessary, the authors stressed. They noted that medical therapies and lifestyle adjustments to avoid triggers may be essential not only in managing the signs and symptoms but in maintaining remission.
The roundtable was made possible by an educational grant from EPI Health.
Gallo RL, Baldwin HE, Stein Gold L, Harper JC. Update on facial erythema in rosacea. J Drugs Dermatol 2021 Aug 1;20(8). Published online July 19, 2021. doi: 10.36849/JDD.6062.