MATERIALS AND METHODS
A panel comprised of 4 dermatologists from China, Taiwan, and Thailand participated in a web conference on December 3, 2021. The overarching purpose of the advisory board meeting was to discuss the role of skincare in treating rosacea in the APAC region. The specific objectives of the advisory board were to: 1) review best practices in managing rosacea and skin barrier dysfunction in Asians to develop statements for publication, 2) determine where prescription treatment and adjunctive skincare products fit in the treatment and maintenance algorithms for Asians with rosacea, 3) develop clinical statements on using prescription treatments and non-prescription skincare for the treatment and maintenance treatment of the cutaneous features of rosacea in Asians, and 4) develop a manuscript discussing these statements and the supporting clinical evidence.
Topics for discussion included: What are some key gaps in rosacea treatment in your region? What are the greatest rosacea education needs in your region? Do you feel you have the right skincare products for patients with rosacea? Is there a need for an APAC-specific rosacea treatment algorithm that includes skincare? What features do you expect in a skincare product for rosacea affected skin?
Pre-Meeting Survey
Before the meeting, the panel completed surveys on the percentage of rosacea subtypes they see in their offices; what they use to treat each type of rosacea (oral and topical, prescription and non-prescription); their first through third choices for non-prescription skincare for a) rosacea monotherapy, b) rosacea adjunctive therapy, and c) rosacea maintenance therapy; the ingredients most important to have and to avoid in non-prescription cleansers and moisturizers; other times to use non-prescription skincare for rosacea therapy; and preferred sunscreens. During the web conference, the panel discussed the summarized survey results. This review details these discussions, including the panel's expert opinions and experiences.
Structured Literature Review
Publications eligible for inclusion in the literature review were guidelines, consensus papers, and reviews describing current best practices in managing rosacea in Asians, including prescription treatment and non-prescription skincare for treatment and maintenance. Also meeting the inclusion criteria were clinical research studies on skincare and rosacea published in English from 2010 to 2021. Exclusion criteria were a lack of original data (unless a review article was deemed relevant) and publications in a language other than English.
The search terms were: rosacea in Asians, pathophysiology, skin barrier dysfunction in rosacea, lipid abnormalities in rosacea prone-skin, prescription treatment and maintenance, rosacea guidelines, algorithm, consensus recommendations, prescription treatment, non-prescription skin care, rosacea skincare, and sunscreen use, cleanser and moisturizers for rosacea treatment, maintenance, adjunctive treatment, efficacy, safety, tolerability, skin irritation of skincare use, quality of life aspects, handling and comfort, treatment adherence.
A dermatologist and a physician-scientist performed the systematic literature search on November 16 and 17, 2021, in PubMed and Google Scholar. Two reviewers independently evaluated the results. Selected publications were graded based on reviewer consensus, and discrepancies were resolved with discussion.9
Topics for discussion included: What are some key gaps in rosacea treatment in your region? What are the greatest rosacea education needs in your region? Do you feel you have the right skincare products for patients with rosacea? Is there a need for an APAC-specific rosacea treatment algorithm that includes skincare? What features do you expect in a skincare product for rosacea affected skin?
Pre-Meeting Survey
Before the meeting, the panel completed surveys on the percentage of rosacea subtypes they see in their offices; what they use to treat each type of rosacea (oral and topical, prescription and non-prescription); their first through third choices for non-prescription skincare for a) rosacea monotherapy, b) rosacea adjunctive therapy, and c) rosacea maintenance therapy; the ingredients most important to have and to avoid in non-prescription cleansers and moisturizers; other times to use non-prescription skincare for rosacea therapy; and preferred sunscreens. During the web conference, the panel discussed the summarized survey results. This review details these discussions, including the panel's expert opinions and experiences.
Structured Literature Review
Publications eligible for inclusion in the literature review were guidelines, consensus papers, and reviews describing current best practices in managing rosacea in Asians, including prescription treatment and non-prescription skincare for treatment and maintenance. Also meeting the inclusion criteria were clinical research studies on skincare and rosacea published in English from 2010 to 2021. Exclusion criteria were a lack of original data (unless a review article was deemed relevant) and publications in a language other than English.
The search terms were: rosacea in Asians, pathophysiology, skin barrier dysfunction in rosacea, lipid abnormalities in rosacea prone-skin, prescription treatment and maintenance, rosacea guidelines, algorithm, consensus recommendations, prescription treatment, non-prescription skin care, rosacea skincare, and sunscreen use, cleanser and moisturizers for rosacea treatment, maintenance, adjunctive treatment, efficacy, safety, tolerability, skin irritation of skincare use, quality of life aspects, handling and comfort, treatment adherence.
A dermatologist and a physician-scientist performed the systematic literature search on November 16 and 17, 2021, in PubMed and Google Scholar. Two reviewers independently evaluated the results. Selected publications were graded based on reviewer consensus, and discrepancies were resolved with discussion.9
RESULTS
Of the 168 papers initially identified, 89 were excluded for lacking data on treatment, maintenance, or adjunctive skincare for Asian patients with rosacea. Of the 79 remaining papers, 30 were excluded on the basis of being duplicates, poor quality, or an older version of an updated review article. Of the remaining 59 papers, 33 were papers on Asian patients with rosacea, 16 were guidelines/algorithms/consensus papers, and one Chinese guideline was included in the Asian papers. The small number of clinical studies on skincare using cleansers and moisturizers for rosacea as an adjunct to treatment and maintenance did not allow for grading.
Results from the literature review are included, where appropriate, to support the following 5 panel-developed statements.
Statement 1: Rosacea, an inflammatory skin disease that leads to impaired skin barrier function, commonly involves the face. Symptoms of rosacea can be bothersome and include pain, stinging, burning, itching, and facial flushing.
Impairment of the skin barrier may play a role in disease occurrence and severity. However, it is unclear if this is causative for rosacea or if it results from the existence of diseased rosacea skin.6 According to the advisors, "Redness and flushing are generally the most challenging symptoms for our rosacea patients, and prescription products do not consistently meet this need." The advisors added, "We need to educate both doctors and patients about rosacea."
Published studies also support these experiences. In a multicenter cross-sectional study at 14 hospitals, researchers evaluated rosacea's epidemiologic and clinical features in patients in Korea using a questionnaire. The questionnaire addressed sociodemographic, rosacea severity and clinical features, and patient awareness of rosacea. Dermatologists used the standard classification and grading system to examine the patients and record rosacea subtype and severity.8
Results from the literature review are included, where appropriate, to support the following 5 panel-developed statements.
Statement 1: Rosacea, an inflammatory skin disease that leads to impaired skin barrier function, commonly involves the face. Symptoms of rosacea can be bothersome and include pain, stinging, burning, itching, and facial flushing.
Impairment of the skin barrier may play a role in disease occurrence and severity. However, it is unclear if this is causative for rosacea or if it results from the existence of diseased rosacea skin.6 According to the advisors, "Redness and flushing are generally the most challenging symptoms for our rosacea patients, and prescription products do not consistently meet this need." The advisors added, "We need to educate both doctors and patients about rosacea."
Published studies also support these experiences. In a multicenter cross-sectional study at 14 hospitals, researchers evaluated rosacea's epidemiologic and clinical features in patients in Korea using a questionnaire. The questionnaire addressed sociodemographic, rosacea severity and clinical features, and patient awareness of rosacea. Dermatologists used the standard classification and grading system to examine the patients and record rosacea subtype and severity.8
