2.179), using exfoliating or oil-control products daily (OR 2.435), facial mask-use (OR 1.559) and deep cleaning of the skin at a beauty salon (OR 2.688).22
On the other hand, studies in Asian patients with rosacea have also revealed what is beneficial. A preliminary observational study evaluated 6 middle-aged female Korean patients with rosacea treated with gauzes soaked with tranexamic acid (TA) solution. TA is an anti-fibrinolytic, and oral TA improves itching, swelling, and erythema and has been used to treat eczema, hives, and drug-induced irritation. The solution was applied for 20 minutes 1 or 2 times a week.23 Erythema and subjective symptoms were assessed at baseline before treatment and at day 5. All patients had a markedly decreased erythema investigator quartile score (0 = none to 4 = very severe). The mean erythema decrease was 2.3. "Patients were satisfied because their skin felt cooled and soothed." The mean visual analog scale (VAS) (0–10) decreases were 3.8 for itching, 1.5 for flushing, and 3.5 for burning.23
A prospective study of 28 patients (26 completed the study) with erythema from rosacea (n=15) and acne (n=11) were treated with dual-frequency ultrasound, impulse mode, once a week for 4 weeks over both cheeks. Clinician's erythema assessment (CEA) and subject satisfaction questionnaire (SSQ) were performed, and transepidermal water loss (TEWL) and skin color change were calculated at each visit (baseline and weeks 2, 4, and 6).24 At week 6, the 4 parameters were significantly improved. TEWL decreased by 5.37 ± 13.22 g·h−1·m−2 (P=.020). The erythema index decreased by 39.73 ± 44.21 (P=.010). At the last follow-up, the CEA (P<.001) and SSQ scores (P=.003) had also significantly improved. No serious adverse events were identified during treatment or follow-up.24
Statement 4: Addressing barrier dysfunction by using cleanser and moisturizer formulations that restore skin hydration, skin lipids, and physiological stratum corneum pH can improve rosacea signs and symptoms and reduce the likelihood of skin irritation.
Rosacea is associated with skin barrier dysfunction, and studies have focused both on better understanding the physiology behind the dysfunction as well as ways to improve it. In a study to better understand the reasons for the barrier dysfunction, researchers analyzed human skin samples from patients with rosacea and controls with healthy skin using quantitative polymerase chain reaction and immunohistochemistry.25 A goal of the study was to measure claudin mRNA in lesional skin since claudins form part of tight junctions.25 The researchers found that patients with rosacea had lower levels of claudin mRNA in lesional skin, especially patients with ETR and PPR, and concluded these findings suggest patients with rosacea have impaired skin barrier.25
Another study focused on relieving rosacea symptoms through moisturizers. This study included ceramides – lipids found in the stratum corneum that help with epidermal differentiation, cell adhesion, the skin's barrier function, and apoptosis.17,26 This randomized, split-leg, investigator-blinded study of females with dry, itchy skin evaluated the impact of a multilamellar vesicular emulsion, ceramide-containing moisturizing cream on skin hydration, visible signs of dry skin, and discomfort. The study also assessed changes in ceramide, cholesterol, and free fatty acid levels in the stratum corneum after applying the cream.27 After 3 days, the skin's water content was significantly greater (30.6% increase, P<.001) in the treatment group than in the control group. Immediately after application, subjects reported significantly improved itching (P<.001), stinging (P<.008), and burning (P=.001). Skin dryness, roughness, desquamation, luminosity, erythema, and overall appearance were also statistically improved immediately, at day 3, and at week 4 (P<.001).27 In the treated leg, total skin ceramide content increased by 10% after 4 weeks of moisturizer and lasted for 24 hours after discontinuation.
A separate study supports the importance of moisturizers in patients with rosacea. In this 7-day multicenter open-label study in patients (n=102) with mild to moderate PPR, patients were treated with azelaic acid gel 15% twice a day, as well as a specific cleanser and moisturizer. The moisturizer was applied only on the right half of the face.18 The study evaluated this regimen's impact on the severity and duration of burning, itching, stinging, and tingling and whether regular moisturizer application relieved symptoms.18 Both moisturizers used at random in the study contain ceramides.28,29 A cumulative symptom score (CSS) was calculated by averaging the separate scores for burning, itching, stinging, and tingling at every point of measurement.18 The mean CSS at end of the study was lower for the side (right) (P=.008) of the face where moisturizer was applied compared with baseline as well as compared with the side without moisturizer (left) (P=.015).18
Another study evaluated a ceramide-containing cream vs a cream without ceramides. Barrier restoring moisturizers can reduce skin irritation and promote a healthy skin barrier. A double-blind, intra-subject control, split body study with 34 subjects 20 to 89 years old with eczema-prone skin.30 The test ceramides containing cream (CER cream)28 or reference cream (a sodium lauryl sulfate-free paraffin-based emollient prescribed by the National Health Service in the United Kingdom) were randomly assigned to one volar forearm and lower leg, and subjects were treated twice a day for 4 weeks.30 Using Fouriertransform infrared (FTIR) spectroscopy, the researchers found that after 28 days of treatment, the ceramide-containing cream increased lipids deep within the stratum corneum.30
On the other hand, studies in Asian patients with rosacea have also revealed what is beneficial. A preliminary observational study evaluated 6 middle-aged female Korean patients with rosacea treated with gauzes soaked with tranexamic acid (TA) solution. TA is an anti-fibrinolytic, and oral TA improves itching, swelling, and erythema and has been used to treat eczema, hives, and drug-induced irritation. The solution was applied for 20 minutes 1 or 2 times a week.23 Erythema and subjective symptoms were assessed at baseline before treatment and at day 5. All patients had a markedly decreased erythema investigator quartile score (0 = none to 4 = very severe). The mean erythema decrease was 2.3. "Patients were satisfied because their skin felt cooled and soothed." The mean visual analog scale (VAS) (0–10) decreases were 3.8 for itching, 1.5 for flushing, and 3.5 for burning.23
A prospective study of 28 patients (26 completed the study) with erythema from rosacea (n=15) and acne (n=11) were treated with dual-frequency ultrasound, impulse mode, once a week for 4 weeks over both cheeks. Clinician's erythema assessment (CEA) and subject satisfaction questionnaire (SSQ) were performed, and transepidermal water loss (TEWL) and skin color change were calculated at each visit (baseline and weeks 2, 4, and 6).24 At week 6, the 4 parameters were significantly improved. TEWL decreased by 5.37 ± 13.22 g·h−1·m−2 (P=.020). The erythema index decreased by 39.73 ± 44.21 (P=.010). At the last follow-up, the CEA (P<.001) and SSQ scores (P=.003) had also significantly improved. No serious adverse events were identified during treatment or follow-up.24
Statement 4: Addressing barrier dysfunction by using cleanser and moisturizer formulations that restore skin hydration, skin lipids, and physiological stratum corneum pH can improve rosacea signs and symptoms and reduce the likelihood of skin irritation.
Rosacea is associated with skin barrier dysfunction, and studies have focused both on better understanding the physiology behind the dysfunction as well as ways to improve it. In a study to better understand the reasons for the barrier dysfunction, researchers analyzed human skin samples from patients with rosacea and controls with healthy skin using quantitative polymerase chain reaction and immunohistochemistry.25 A goal of the study was to measure claudin mRNA in lesional skin since claudins form part of tight junctions.25 The researchers found that patients with rosacea had lower levels of claudin mRNA in lesional skin, especially patients with ETR and PPR, and concluded these findings suggest patients with rosacea have impaired skin barrier.25
Another study focused on relieving rosacea symptoms through moisturizers. This study included ceramides – lipids found in the stratum corneum that help with epidermal differentiation, cell adhesion, the skin's barrier function, and apoptosis.17,26 This randomized, split-leg, investigator-blinded study of females with dry, itchy skin evaluated the impact of a multilamellar vesicular emulsion, ceramide-containing moisturizing cream on skin hydration, visible signs of dry skin, and discomfort. The study also assessed changes in ceramide, cholesterol, and free fatty acid levels in the stratum corneum after applying the cream.27 After 3 days, the skin's water content was significantly greater (30.6% increase, P<.001) in the treatment group than in the control group. Immediately after application, subjects reported significantly improved itching (P<.001), stinging (P<.008), and burning (P=.001). Skin dryness, roughness, desquamation, luminosity, erythema, and overall appearance were also statistically improved immediately, at day 3, and at week 4 (P<.001).27 In the treated leg, total skin ceramide content increased by 10% after 4 weeks of moisturizer and lasted for 24 hours after discontinuation.
A separate study supports the importance of moisturizers in patients with rosacea. In this 7-day multicenter open-label study in patients (n=102) with mild to moderate PPR, patients were treated with azelaic acid gel 15% twice a day, as well as a specific cleanser and moisturizer. The moisturizer was applied only on the right half of the face.18 The study evaluated this regimen's impact on the severity and duration of burning, itching, stinging, and tingling and whether regular moisturizer application relieved symptoms.18 Both moisturizers used at random in the study contain ceramides.28,29 A cumulative symptom score (CSS) was calculated by averaging the separate scores for burning, itching, stinging, and tingling at every point of measurement.18 The mean CSS at end of the study was lower for the side (right) (P=.008) of the face where moisturizer was applied compared with baseline as well as compared with the side without moisturizer (left) (P=.015).18
Another study evaluated a ceramide-containing cream vs a cream without ceramides. Barrier restoring moisturizers can reduce skin irritation and promote a healthy skin barrier. A double-blind, intra-subject control, split body study with 34 subjects 20 to 89 years old with eczema-prone skin.30 The test ceramides containing cream (CER cream)28 or reference cream (a sodium lauryl sulfate-free paraffin-based emollient prescribed by the National Health Service in the United Kingdom) were randomly assigned to one volar forearm and lower leg, and subjects were treated twice a day for 4 weeks.30 Using Fouriertransform infrared (FTIR) spectroscopy, the researchers found that after 28 days of treatment, the ceramide-containing cream increased lipids deep within the stratum corneum.30
