Evidence of Barrier Deficiency in Rosacea and the Importance of Integrating OTC Skincare Products into Treatment Regimens

April 2021 | Volume 20 | Issue 4 | Original Article | 384 | Copyright © April 2021


Published online March 16, 2021

Hilary Baldwin MDa, Andrew F. Alexis MD MPHb, Anneke Andriessen PhDc, Diane S. Berson MD FAADd, Patricia Farris MD FAADe, Julie Harper MDf, Edward Lain MD FAADg, Shari Marchbein MDh, Linda Stein Gold MDi, Jerry Tan FRCPCj

aAcne Treatment & Research Center, Brooklyn, NY
bIcahn School of Medicine at Mount Sinai, New York, NY
cRadboud UMC Nijmegen, Andriessen Consultants, Malden, The Netherlands
dCornell University Weill Medical College, Weill Cornell Medical Center, Dermatology, New York, NY
eTulane University School of Medicine, New Orleans, LA; Sanova Dermatology, Metairie, LA
fThe Dermatology and Skin Care Center of Birmingham, Birmingham, AL
gSanova Dermatology, Austin TX; Austin Institute for Clinical Research, Austin, TX
hNYU School of Medicine, New York, NY
iHenry Ford Health System, Detroit, MI
jRoyal College of Physicians and Surgeons of Canada; Schulich School of Medicine and Dentistry, Department of Medicine, Western University, Windsor, ON, Canada; Windsor Clinical Research Inc; The Healthy Image Centre, Windsor, ON, Canada

Abstract
Background: Rosacea, an inflammatory skin disease that leads to an impaired skin barrier function commonly involves the face. Symptoms of rosacea can be bothersome and include pain, stinging, burning, itching, and facial flushing. This review explored skin barrier impairment in rosacea and reduced symptomatology when using over the counter (OTC) skincare products.
Methods: Nine dermatologists (the panel) completed a survey on OTC products they recommend for rosacea. The survey results were summarized, presented, and discussed during the online meeting, together with the results of a literature review. The outcome of these discussions, coupled with the panel's expert opinion and experience, is shown in the current review.
Results: Addressing barrier dysfunction by use of moisturizer and cleanser formulations that restore skin hydration, normalize skin pH, restore the microbiome, and skin lipids can assist in improving rosacea signs and symptoms. The panel's consensus was that in addition to the use of prescription medications, skincare recommendations are a crucial part of successful rosacea therapy. In addition to occlusives and humectants, barrier restoring ingredients such as ceramides, hyaluronic acid, and niacinamide were considered beneficial. Equally important was the absence of potentially irritating substances.
Conclusions: The use of OTC products can improve rosacea symptomatology and signs. As adjuncts, these products are recommended before and during prescription therapy and as part of a maintenance regimen.

J Drugs Dermatol. 20(4):384-392. doi:10.36849/JDD.5861

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INTRODUCTION

Rosacea is a chronic skin disorder characterized by inflammation and vasculopathy.1-3 About 5%–10% of the population is affected by rosacea, which has been said to be most prevalent in Caucasian women from the Northern hemisphere; this is likely due to reporting bias.3 Additionally, numerous recent reports highlight rosacea in other skin phototypes including in Asian and African populations.4,5 Genetic factors play a clear but ill-defined role.3,4 Commonly involving the central face, rosacea lesions, and erythema are most prominent on the cheeks, forehead, chin, and nose.1,2,4 Symptoms of rosacea include stinging, burning and itching, and facial flushing.1,2,4,6-8 Recently the classification of rosacea has been revamped.1,2,6 Numerous expert groups are now recommending a more patient-focused phenotype approach due to shortcomings in the classification of rosacea by subtypes. The former more accurately reflects the myriad clinical presentations of rosacea patients rather than artificially conflating them into subtype categories. Additionally,