A Review of the Challenges and Nuances in Treating Rosacea in Asian Skin Types Using Cleansers and Moisturizers as Adjuncts

January 2023 | Volume 22 | Issue 1 | 45 | Copyright © January 2023


Published online January 1, 2023

doi:10.36849/JDD.7021 Citation: Kulthanan K, Andriessen A, Jiang X, et al. A review of the challenges and nuances in treating rosacea in asian skin types using cleansers and moisturizers as adjuncts. J Drugs Dermatol. 2023;22(1):45-53. doi: 10.36849/JDD.7021. 

Kanokvalai Kulthanan MDa, Anneke Andriessen PhDb, Xian Jiang MD PhDc, Chih-Hung Lee MD PhDd, Cheng-Feng Zhang MD PhDe

aDepartment of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
bAndriessen Consultants and Radboud University, Nijmegen, The Netherlands
cDepartment of Dermatology, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology (CIII), Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
dDepartment of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan eDepartment of Dermatology, Huashan Hospital of Fudan University, Shanghai, China

Abstract
Background: Rosacea is primarily an inflammatory disease of facial skin associated with impaired skin barrier function. While it is commonly thought of as a Caucasian person's disease, it is likely underdiagnosed in people of color, including Asians, leading to missed and delayed diagnoses and increased morbidity. The purpose of this review is to highlight literature on rosacea in Asian people and the role of non-prescription skincare in managing rosacea.
Methods: Four dermatologists (the panel) completed pre-meeting surveys and participated in a web meeting to discuss the role of skin care in treating rosacea in the Asia Pacific (APAC) region. The survey results were summarized, then presented during the virtual meeting. These survey results and relevant papers identified through a literature review were then discussed. This review shows the fruit of these discussions, as well as the advisors' expert opinions and experiences.
Results: The panel crafted 5 consensus statements regarding the role of skin care in the treatment of rosacea in the APAC region. The most common forms of rosacea seen by the advisors are mostly erythematous and papulopustular. Among the panel, doxycycline is the most popular treatment for papulopustular rosacea. The panel prioritize gentleness when choosing skincare products for patients with rosacea.
Conclusions: In Asian patients with rosacea, adjunctive skincare is an important part of treatment, maintenance, and prescription treatment. Given the highly sensitive skin of certain Asian patients with rosacea, avoiding potentially irritating substances is crucial.

J Drugs Dermatol. 2023;22(1):45-53. doi:10.36849/JDD.7021

Citation: Kulthanan K, Andriessen A, Jiang X, et al. A review of the challenges and nuances in treating rosacea in asian skin types using cleansers and moisturizers as adjuncts. J Drugs Dermatol. 2023;22(1):45-53. doi: 10.36849/JDD.7021. 

INTRODUCTION

An inflammatory skin disease associated with impaired skin barrier function, rosacea commonly involves the face.1-3 Symptoms of rosacea can be bothersome and include pain, stinging, burning, itching, and facial flushing.1-4 Triggers include alcohol, cold, heat, physical activity, stress, spicy food, and ultra-violet light.5,6

An estimated 5.46% of the global adult population has rosacea, and it is most common in women 30 years and older.5 Because rosacea is often considered a disease of patients with Fitzpatrick skin phototypes I and II, the mistaken notion exists that people with skin of color do not develop rosacea.7 In fact, rosacea is likely underrecognized in people of color, and under-recognition can lead to misdiagnosis and delayed diagnosis and, therefore, greater morbidity.7 Various studies on Asian populations with rosacea have shown that patients may have their skin complaints on average 5 years before receiving effective treatment.8

Data characterizing rosacea in Asian skin types are limited, and the awareness of rosacea in this population is relatively low. To better understand the unique aspects of rosacea and nuances in the treatment approaches using cleansers and moisturizers in this population, 4 dermatologists from Asia (the panel) completed a survey on the non-prescription skincare products they recommend for rosacea.
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