Cross-Sectional Survey of the Burden of Illness of Rosacea by Erythema Severity
February 2018 | Volume 17 | Issue 2 | Original Article | 150 | Copyright © February 2018
Julie Harper MD,a James Q. Del Rosso DO,b Ilia L. Ferrusi PhDc
aDermatology and Skin Care Center of Birmingham, Birmingham, AL bTouro University Nevada, Henderson, Nevada and Del Rosso Dermatology Research, Las Vegas, NV cNovartis Pharmaceuticals, East Hanover, NJ* *IL Ferrusi was an employee of Allergan plc at the time the study was conducted.
Abstract
Rosacea is a chronic skin condition characterized by persistent central facial erythema. To explore the burden of illness of rosacea in US adults, a cross-sectional web-based survey was conducted. Participants answered questions on sociodemographics, clinical characteristics, bothersome symptoms, coping and avoidance behaviors, self-perceptions, and health care resource utilization, and completed 2 quality of life instruments, the 21-item rosacea-specific quality of life questionnaire (RosaQoL) and the 36-item Short Form Health Survey (SF-36). This paper reports the data from the 409 respondents with erythematotelangiectatic rosacea (ETR), analyzed by erythema severity. Mean age was 53.1 years; mild, moderate, or severe erythema was reported by 63.6%, 32.0%, and 4.4% of participants, respectively. Blushing/flushing and bumps/pustules were the most bothersome symptoms across severity subgroups. Participants in all subgroups coped with rosacea by applying make-up and managing their stress and anxiety, and tried to prevent rosacea flares by avoiding sun exposure, specific skin care products, and other triggers. Self-perceptions differed by severity subgroup:
satisfaction with facial appearance significantly decreased, and worrying about how people will react and feelings of unattractiveness to others significantly increased, with greater erythema severity (all P less than 0.01). Treatment or assessment of rosacea was sought by 20% of participants in the past 3 months, most commonly from a dermatologist. Metronidazole was the most frequently prescribed topical product across severity subgroups, whereas doxycycline and other oral antibiotics were prescribed most frequently in the severe erythema subgroup. RosaQoL emotional domain scores increased with erythema severity (P equals 0.0035), but none of the SF-36 domain scores differed significantly by erythema severity. These results demonstrate that rosacea is associated with a substantial burden of illness that spans all levels of erythema severity in patients with ETR. Feelings of unattractiveness and the adverse impact of rosacea on emotional quality of life increased with erythema severity.
J Drugs Dermatol. 2018;17(2):150-158.
INTRODUCTION
Rosacea is a chronic skin condition characterized by persistent erythema on the central face that affects an estimated 16 million adults in the United States.1-3 Rosacea can be further categorized based on clinical manifestations; the 2 most common subtypes are erythematotelangiectatic rosacea (ETR), characterized by persistent central facial erythema, telangiectasia, and transient flushing, and papulopustular rosacea (PPR), which involves persistent central facial erythema with inflammatory lesions (papules or pustules).1,2 Although the National Rosacea Society distinguishes 4 rosacea subtypes, the broad extent of interrelated rosacea signs, of which persistent erythema is the hallmark, results in the overlapping of subtypes and underscores the importance of treating an individual patient’s specific signs.4 Effective treatment options for persistent facial erythema of rosacea are limited, as most available agents approved by the US Food and Drug Administration to treat inflammatory lesions of rosacea provide no therapeutic benefit for persistent erythema.5 Rosacea has a moderate impact on quality of life (QoL) as measured with the Dermatology Life Quality Index, with impairments influenced by patient age, sex, age at disease onset, symptoms, triggering factors, and rosacea severity.6 Because rosacea is a chronic condition, patients may feel shame and embarrassment, and have low self-esteem, negative body image, social dysfunction, depression, anxiety, and stress.7-9 In a survey of more than 400 patients with rosacea conducted by the National Rosacea Society, 75% reported having low self-esteem and 70% reported being embarrassed by their skin condition.10 Persistent signs and symptoms including erythema, inflammatory lesions, and skin burning and stinging may cause physical discomfort, which may also contribute to reduced QoL.8 This report describes the burden of illness of ETR by erythema severity based on findings from a cross-sectional, web-based survey that explored the burden of illness associated with rosacea in US patients. The full results of the survey are reported separately.
