INTRODUCTION
Rosacea is a common disorder affecting 16 million people in the US alone.1 Despite earlier beliefs that rosacea was primarily a disease of light-skinned Caucasian, middle-aged women, we now know that it affects all races and age groups. Erythema may be more difficult to appreciate in patients with skin types IV and V, but papules, pustules, and granulomatous lesions are commonly seen. It is unclear if rosacea is truly more common (2-3 fold) in women or if men are simply less likely to seek clinical care.2 There are some gender differences, however, as men are far more likely to have phymatous rosacea.3 The diagnosis of rosacea is most often made in patients in their 30s-50s, but all ages are susceptible.4
To truly understand the impact of rosacea, the psychosocial impact
of the disease must be factored in. For many patients, the stigma of a “rum blossom†or “drinker’s nose†and the social and professional isolation that result from low self-esteem and prejudice
is far more significant than the clinical appearance alone.
It is a clinical reality that we don’t truly treat rosacea, but rather manage it: we do not offer cure but control. As with all incurable conditions, frustrations with inadequate therapy and chronicity of therapy plagues rosacea treatment plans. Benefits from a combination of both medical and psychological approaches to care cannot be overemphasized. The overall goal is the improvement
of the quality of life of the patient. No two patients will be alike in their needs in this regard. The desire for resolution
of persistent erythema, however, is ubiquitous.
For the task of discussing therapy, and drawing useful and valid conclusions from clinical data, a classification system based on predominant lesion morphology was developed by committee of the National Rosacea Society.5 In this system, patients are classified as having one of four types: erythematotelangiectatic, papulopustular, phymatous, or ocular with a variant form referred to as granulomatous. Individual patients may straddle one or more subtypes, but this system allows us to evaluate therapy based on similar lesion types. Erythema and telangiectasia are the hallmarks of erythematotelangiectatic
rosacea, but are commonly seen as accompaniments of the other variants.
When measuring erythema and assessing response to rosacea therapy, it is crucial to define the difference between perilesional erythema and “background erythemaâ€. Inflammatory lesions of rosacea are, by definition, red. There is often significant surrounding erythema as a result of the inflammatory process. As lesions resolve with therapy, the lesional and perilesional erythema improves. Particularly
