CONCLUSION
Rosacea is a disease of skin inflammation that leads to derangements in skin barrier function. This contributes to the sensation of pain, burning, itching, stinging so often bothersome in those affected. Addressing barrier dysfunction by using moisturizer and cleanser formulations that restore skin hydration, normalize skin pH, and restore the microbiome and skin lipids can help improve 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. Participants noted that the use of quality OTC products could improve rosacea symptomatology and severity in and of themselves. As adjuncts, these products are recommended before and during prescription therapy and as part of a maintenance regimen.
The importance of providing the patients with specific branded recommendations was discussed both in terms of the presence of reparative actives and the omission of irritating substances. 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. In particular, cleansers with harsh surfactants, antibiotics, and elevated pH can strip lipids, proteins, and NMF, thereby stimulating inflammation.
Patients benefit from specific recommendations when faced with the bewildering array of options in the pharmacy skincare aisle. The wrong choice can derail an otherwise ideal therapeutic approach.
Limitations
There are many types of OTC skincare products available; however, robust comparative studies on their use for rosacea are scarce. Information from studies that combine biophysical measurements with clinical assessment may help to make an informed choice.
The panel's consensus was that in addition to the use of prescription medications, skincare recommendations are a crucial part of successful rosacea therapy. Participants noted that the use of quality OTC products could improve rosacea symptomatology and severity in and of themselves. As adjuncts, these products are recommended before and during prescription therapy and as part of a maintenance regimen.
The importance of providing the patients with specific branded recommendations was discussed both in terms of the presence of reparative actives and the omission of irritating substances. 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. In particular, cleansers with harsh surfactants, antibiotics, and elevated pH can strip lipids, proteins, and NMF, thereby stimulating inflammation.
Patients benefit from specific recommendations when faced with the bewildering array of options in the pharmacy skincare aisle. The wrong choice can derail an otherwise ideal therapeutic approach.
Limitations
There are many types of OTC skincare products available; however, robust comparative studies on their use for rosacea are scarce. Information from studies that combine biophysical measurements with clinical assessment may help to make an informed choice.
DISCLOSURES
The authors disclosed receipt of an unrestricted educational grant from CeraVe USA for support with this work's research. The authors also received consultancy fees for their work on this project.
All authors contributed to the development and review of this work and agreed with the content.
All authors contributed to the development and review of this work and agreed with the content.
REFERENCES
1. Gallo RL, Granstein RD, Kang S et al. Standard classification and pathophysiology of rosacea: the 2017 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. 2018; 78: 148– 55.
2. Schaller M, Almeida LMC, Bewley A et al. Recommendations for rosacea diagnosis, classification, and management: update from the global ROSacea Consensus 2019 panel. Br J Dermatol. 2020; 182:1909-1091.
3. Tan J, Schöfer H, Araviiskaia E, Audibert F, Kerrouche N, Berg M, The RISE study group Prevalence of rosacea in the general population of Germany and Russia—the RISE study. J Eur Acad Dermatol Venereol. 2016;30:428– 434. doi: 10.1111/jdv.13556. [Europe PMC free article] [Abstract] [CrossRef] [Google Scholar]
4. Woo YR, Lim JH, Cho DH, Park HJ. Rosacea: molecular mechanisms and management of a chronic cutaneous inflammatory condition. Int J Mol Sci. 2016; 17(9):1562; doi:10.3390/ijms17091562
5. Alexis AF, Callender VD, Baldwin HE, Desai SR, Rendon MI, Taylor SC. Global epidemiology and clinical spectrum of rosacea, highlighting skin of color. Review and clinical practice experience. J Am Acad Dermatol. 2019;80(6):1722-1729. DOI:https://doi.org/10.1016/j.jaad.2018.08.049
6. van Zuuren EJ, Fedorowicz Z, Tan J et al. Interventions for rosacea based on the phenotype approach: An updated systematic review including GRADE assessments. Br J Dermatol. 2019;181:65-79.
7. Addor F. Skin barrier in rosacea A review. An Bras Dermatol. 2016;91(1):59- 63. doi: http://dx.doi.org/10.1590/abd1806-4841.2016354
8. Tan J, Almeida L, Bewley A, et al. Updating the diagnosis, classification and assessment of rosacea: recommendations from the global ROSacea COnsensus (ROSCO) panel. Brit J Dermatol. 2017;176:431â€438.
9. Darlenski R, Kazandijeva J, Tsankov N, Fluhr JW. Acute irritant threshold correlates with barrier function, skin hydration and contact hypersensitivity in atopic dermatitis and rosacea. Experimental Dermatol. 2013 (9) https://doi. org/10.1111/exd.12251
10. Tan J, Blume-Peytavi U, Ortonne JP, Wilhelm K, Marticou L, Baltas E, et al. An observational cross-sectional survey of rosacea: clinical associations and progression between subtypes. Br J Dermatol. 2013;169:555-62.
11. Schaller M, Almeida L, Bewley A, et al. Recommendations for rosacea diagnosis, classification and management: update from the global ROSacea Consensus 2019 panel. Br J Dermatol. 2020;182:1909-1091.
12. Steinhoff M, Buddenkotte J, Aubert J, et al. Clinical, cellular and molecular aspects in the pathophysiology of rosacea. J Investig Dermatol Symp Proc. 2011;15(1):2-11.
13. Two AM, Wu W, Gallo RL, et al. Rosacea: Part 1. Introduction, categorization, histology, pathophysiology and risk factors. J Am Acad Dermatol. 2015 72(5):749-58.
14. Kulkarni NN, Takahashi T, Sanford JA, et al. Innate immune dysfunction in rosacea promotes photosensitivity and vascular adhesion molecule expression. J Invest Dermatol. 2020;140(3):645-655. e6. doi: 10.1016/j. jid.2019.08.436.
15. Dirschka T, Tronnier H, Folster-Holtz R. Epthelial barrier function and atopic diathesis in rosacea and perioral dermatitis. Br J Dermatol. 2004;150(6):1136- 1141.
16. Choi MJ, Maibach HI. Role of ceramides in barrier function of healthy and diseased skin. Am J Clin Dermatol. 2005;6(4):215-223.
17. Yamamoto A, Takenouchi K, Ito M. Impaired water barrier function in acne vulgaris. Arch Dermatol Res. 1995;287:214-218.
18. Di Nardo A. Wertz P, Giannetti A, Seidenari S. Ceramide and cholesterol composition of the skin of patients with atopic dermatitis. Acta Derm Venereol. 1998;78:27-30. doi: 10.1080/00015559850135788.
19. Motta S. Monti M, Sesana S, Mellesi L, Ghidoni R, Caputo R. Abnormality of water barrier function in psoriasis. Role of ceramide fractions. Arch Dermatol. 1994;130 (4):452-456. PMID: 8166482
20. Paige DG, Morse-Fischer N, Harper JL. Quantification of stratum corneum ceramides and lipid envelope ceramides in hereditary ichthyoses. Br. J Dermatol. 1994;131:23-7.
21. Perisho K, Wertz PW, Madison KC, Stewart ME, Downing DT. Fatty acids of acylceramides from comedones and from the skin surface of acne patients and control subjects J. Invest. Dermatol. 1988; 90:350-353.
22. Di Nardo A, Sugino K, Wertz P, Ademola J, Maibach HI. Sodium lauryl sulfate (SLS) induced irritant contact dermatitis: a correlation study between ceramides and in vivo parameters of irritation Contact Dermatitis. 1996;35:86-91.
23. Draelos ZD. The effect of ceramide-containing skin care products on eczema resolution duration. Cutis. 2008;81:87-91. PMID: 183006855
24. Draelos ZD, Baalbaki NH, Cook S, Raab S, Colon G. The effect of a ceramidecontaining product on stratum corneum lipid levels in dry legs. J Drugs Dermatol. 2020;19(4)372-376.
25. Lueangarun S, Tragulplaingam P, Sugkraroek S. The 24-hr, 28-day, and 7-day post-moisturizing efficacy of ceramides 1, 3, 6-II containing moisturizing cream on skin dryness and barrier disruption in senile xerosis treatment. Dermatol Ther. 2019;32(6)e13090. https://doi.org/10.1111/dth.13090.
26. Lynde CW, Andriessen A. A cohort study on ceramide-containing cleanser and moisturizer used for atopic dermatitis. Cutis. 2014;93:207-213.
27. Crawford GH, Pelle MH, James WD. Rosacea: I. Etiology, pathogenesis, and subtype classification. J Am Acad Dermatol. 2004:327–341.
28. Del Rosso JQ. The use of moisturizers as an integral component of topical therapy for rosacea: clinical results based on assessment of skin
2. Schaller M, Almeida LMC, Bewley A et al. Recommendations for rosacea diagnosis, classification, and management: update from the global ROSacea Consensus 2019 panel. Br J Dermatol. 2020; 182:1909-1091.
3. Tan J, Schöfer H, Araviiskaia E, Audibert F, Kerrouche N, Berg M, The RISE study group Prevalence of rosacea in the general population of Germany and Russia—the RISE study. J Eur Acad Dermatol Venereol. 2016;30:428– 434. doi: 10.1111/jdv.13556. [Europe PMC free article] [Abstract] [CrossRef] [Google Scholar]
4. Woo YR, Lim JH, Cho DH, Park HJ. Rosacea: molecular mechanisms and management of a chronic cutaneous inflammatory condition. Int J Mol Sci. 2016; 17(9):1562; doi:10.3390/ijms17091562
5. Alexis AF, Callender VD, Baldwin HE, Desai SR, Rendon MI, Taylor SC. Global epidemiology and clinical spectrum of rosacea, highlighting skin of color. Review and clinical practice experience. J Am Acad Dermatol. 2019;80(6):1722-1729. DOI:https://doi.org/10.1016/j.jaad.2018.08.049
6. van Zuuren EJ, Fedorowicz Z, Tan J et al. Interventions for rosacea based on the phenotype approach: An updated systematic review including GRADE assessments. Br J Dermatol. 2019;181:65-79.
7. Addor F. Skin barrier in rosacea A review. An Bras Dermatol. 2016;91(1):59- 63. doi: http://dx.doi.org/10.1590/abd1806-4841.2016354
8. Tan J, Almeida L, Bewley A, et al. Updating the diagnosis, classification and assessment of rosacea: recommendations from the global ROSacea COnsensus (ROSCO) panel. Brit J Dermatol. 2017;176:431â€438.
9. Darlenski R, Kazandijeva J, Tsankov N, Fluhr JW. Acute irritant threshold correlates with barrier function, skin hydration and contact hypersensitivity in atopic dermatitis and rosacea. Experimental Dermatol. 2013 (9) https://doi. org/10.1111/exd.12251
10. Tan J, Blume-Peytavi U, Ortonne JP, Wilhelm K, Marticou L, Baltas E, et al. An observational cross-sectional survey of rosacea: clinical associations and progression between subtypes. Br J Dermatol. 2013;169:555-62.
11. Schaller M, Almeida L, Bewley A, et al. Recommendations for rosacea diagnosis, classification and management: update from the global ROSacea Consensus 2019 panel. Br J Dermatol. 2020;182:1909-1091.
12. Steinhoff M, Buddenkotte J, Aubert J, et al. Clinical, cellular and molecular aspects in the pathophysiology of rosacea. J Investig Dermatol Symp Proc. 2011;15(1):2-11.
13. Two AM, Wu W, Gallo RL, et al. Rosacea: Part 1. Introduction, categorization, histology, pathophysiology and risk factors. J Am Acad Dermatol. 2015 72(5):749-58.
14. Kulkarni NN, Takahashi T, Sanford JA, et al. Innate immune dysfunction in rosacea promotes photosensitivity and vascular adhesion molecule expression. J Invest Dermatol. 2020;140(3):645-655. e6. doi: 10.1016/j. jid.2019.08.436.
15. Dirschka T, Tronnier H, Folster-Holtz R. Epthelial barrier function and atopic diathesis in rosacea and perioral dermatitis. Br J Dermatol. 2004;150(6):1136- 1141.
16. Choi MJ, Maibach HI. Role of ceramides in barrier function of healthy and diseased skin. Am J Clin Dermatol. 2005;6(4):215-223.
17. Yamamoto A, Takenouchi K, Ito M. Impaired water barrier function in acne vulgaris. Arch Dermatol Res. 1995;287:214-218.
18. Di Nardo A. Wertz P, Giannetti A, Seidenari S. Ceramide and cholesterol composition of the skin of patients with atopic dermatitis. Acta Derm Venereol. 1998;78:27-30. doi: 10.1080/00015559850135788.
19. Motta S. Monti M, Sesana S, Mellesi L, Ghidoni R, Caputo R. Abnormality of water barrier function in psoriasis. Role of ceramide fractions. Arch Dermatol. 1994;130 (4):452-456. PMID: 8166482
20. Paige DG, Morse-Fischer N, Harper JL. Quantification of stratum corneum ceramides and lipid envelope ceramides in hereditary ichthyoses. Br. J Dermatol. 1994;131:23-7.
21. Perisho K, Wertz PW, Madison KC, Stewart ME, Downing DT. Fatty acids of acylceramides from comedones and from the skin surface of acne patients and control subjects J. Invest. Dermatol. 1988; 90:350-353.
22. Di Nardo A, Sugino K, Wertz P, Ademola J, Maibach HI. Sodium lauryl sulfate (SLS) induced irritant contact dermatitis: a correlation study between ceramides and in vivo parameters of irritation Contact Dermatitis. 1996;35:86-91.
23. Draelos ZD. The effect of ceramide-containing skin care products on eczema resolution duration. Cutis. 2008;81:87-91. PMID: 183006855
24. Draelos ZD, Baalbaki NH, Cook S, Raab S, Colon G. The effect of a ceramidecontaining product on stratum corneum lipid levels in dry legs. J Drugs Dermatol. 2020;19(4)372-376.
25. Lueangarun S, Tragulplaingam P, Sugkraroek S. The 24-hr, 28-day, and 7-day post-moisturizing efficacy of ceramides 1, 3, 6-II containing moisturizing cream on skin dryness and barrier disruption in senile xerosis treatment. Dermatol Ther. 2019;32(6)e13090. https://doi.org/10.1111/dth.13090.
26. Lynde CW, Andriessen A. A cohort study on ceramide-containing cleanser and moisturizer used for atopic dermatitis. Cutis. 2014;93:207-213.
27. Crawford GH, Pelle MH, James WD. Rosacea: I. Etiology, pathogenesis, and subtype classification. J Am Acad Dermatol. 2004:327–341.
28. Del Rosso JQ. The use of moisturizers as an integral component of topical therapy for rosacea: clinical results based on assessment of skin
