MATERIALS AND METHODS
A panel of five dermatologists from the US (the authors) convened a meeting on August 7, 2021, during the American Academy of Dermatology (AAD) Summer Meeting. The objectives of the meeting were to gain a better understanding of the unique aspects of rosacea in SOC patients and nuances in the treatment approaches of this population.
Additionally, the panel discussed the role of skincare comprising gentle cleansers and moisturizers as adjuncts in treating and maintaining rosacea in SOC patients. Finally, the ingredients of these skincare products were explored, offering insights into the specific role of common key ingredients in cleanser and moisturizer formulations for SOC rosacea patients that may be beneficial or should be avoided.
Literature Review
In preparation for the meeting, a literature review was conducted on treating and maintaining rosacea and skincare as adjuncts to treatment in different racial/ethnic populations. Searches for English-language literature [2015–2021] took place on June 24, 2021, on PubMed, with Google Scholar as a secondary source. The literature review gave priority to clinical studies published on SOC patients with rosacea and articles describing the current best practices in caring for cutaneous features of rosacea and skin barrier dysfunction. The rosacea literature was reviewed for inclusion of SOC, looking at demographics to include nonwhite populations, Fitzpatrick skin types IV–VI, various ethnic populations, and publications from regions with these populations. Further recent clinical guidelines, consensus papers, and algorithms on rosacea and skincare that specifically addressed nonwhite populations, Fitzpatrick skin types IV–VI, various ethnic populations, and regions with these populations were included in the searches.
Excluded were duplications, articles of insufficient quality [small sample size, flawed methodology], and the most recent publication was used in the case of review articles.
The search terms used focused on SOC rosacea patients nonwhite populations, Fitzpatrick skin types IV–VI, various ethnic populations, and regions with these populations: Rosacea, pathophysiology, skin barrier dysfunction in rosacea in SOC patients, lipid abnormalities in rosacea-prone skin, prescription treatment, and maintenance for SOC rosacea patients, rosacea guidelines for various ethnic groups, algorithm, consensus recommendations.
Further searches culled articles from the literature: OTC rosacea skincare and sunscreen use, cleansers, and moisturizers for rosacea SOC patients nonwhite populations, Fitzpatrick skin types IV-VI, various ethnic populations, and regions with these populations treatment, maintenance, adjunctive treatment, efficacy, safety, tolerability, and skin irritation from OTC skincare use, quality of life aspects, handling, and comfort, adherence to treatment in SOC populations, nonwhite populations, Fitzpatrick skin types IV–VI, various ethnic populations and regions with these populations.
Of the 168 papers, 104 lacked data contributing to SOC rosacea patients and adjunctive skincare use, leaving 64 articles for further review. After removing 14 duplicate articles, 50 remained; however, the small number of clinical studies on skincare using cleansers and moisturizers as an adjunct to treatment and maintenance for SOC patients with rosacea did not allow for a systematic literature review and grading of the evidence.
Development of Statements
During the meetings workshop, the panel members discussed the recommendations on rosacea treatment in SOC patients and skincare given in clinical studies, clinical guidelines, consensus papers, and algorithms available per region with different racial/ ethnic populations. Drawing from fourteen draft statements, the advisors agreed on five statements for insights and recommendations on treating cutaneous features of rosacea in SOC populations.
Rosacea Occurrence in Various Ethnic Populations
Statement 1: Although data are limited, studies and anecdotal clinical experience suggest that rosacea is more common in individuals with darker skin than previously reported.
Currently, data on nonwhite rosacea patients are limited.
Earlier data from 1935 and the 1980s comprises small-size case studies and are therefore not included in the discussion. Recent studies and anecdotal clinical experience suggest that rosacea is more common in individuals of African ancestry with richly pigmented skin than previously reported. A 1993-2010 US National ambulatory medical care survey on the racial/ethnic distribution of patients with rosacea showed that 2% of rosacea patients were Black, and 2.3% of clinicians believed that rosacea does not occur in people with SOC.8,19-21
A 5-year longitudinal cohort study of 705 rosacea patients included 421 (16.27%) African-American and 284 (10.98%) other SOC rosacea patients on North Carolina Medicaid. In this study, physicians prescribed at least one topical rosacea treatment (metronidazole, adapalene, azelaic acid, permethrin, or sulfacetamide).9
Various publications, including the treatment and maintenance of rosacea SOC patients, showed that rosacea might be less common in deeply pigmented patients than in White populations but is not rare.8,10-14,19-22
Additionally, the panel discussed the role of skincare comprising gentle cleansers and moisturizers as adjuncts in treating and maintaining rosacea in SOC patients. Finally, the ingredients of these skincare products were explored, offering insights into the specific role of common key ingredients in cleanser and moisturizer formulations for SOC rosacea patients that may be beneficial or should be avoided.
Literature Review
In preparation for the meeting, a literature review was conducted on treating and maintaining rosacea and skincare as adjuncts to treatment in different racial/ethnic populations. Searches for English-language literature [2015–2021] took place on June 24, 2021, on PubMed, with Google Scholar as a secondary source. The literature review gave priority to clinical studies published on SOC patients with rosacea and articles describing the current best practices in caring for cutaneous features of rosacea and skin barrier dysfunction. The rosacea literature was reviewed for inclusion of SOC, looking at demographics to include nonwhite populations, Fitzpatrick skin types IV–VI, various ethnic populations, and publications from regions with these populations. Further recent clinical guidelines, consensus papers, and algorithms on rosacea and skincare that specifically addressed nonwhite populations, Fitzpatrick skin types IV–VI, various ethnic populations, and regions with these populations were included in the searches.
Excluded were duplications, articles of insufficient quality [small sample size, flawed methodology], and the most recent publication was used in the case of review articles.
The search terms used focused on SOC rosacea patients nonwhite populations, Fitzpatrick skin types IV–VI, various ethnic populations, and regions with these populations: Rosacea, pathophysiology, skin barrier dysfunction in rosacea in SOC patients, lipid abnormalities in rosacea-prone skin, prescription treatment, and maintenance for SOC rosacea patients, rosacea guidelines for various ethnic groups, algorithm, consensus recommendations.
Further searches culled articles from the literature: OTC rosacea skincare and sunscreen use, cleansers, and moisturizers for rosacea SOC patients nonwhite populations, Fitzpatrick skin types IV-VI, various ethnic populations, and regions with these populations treatment, maintenance, adjunctive treatment, efficacy, safety, tolerability, and skin irritation from OTC skincare use, quality of life aspects, handling, and comfort, adherence to treatment in SOC populations, nonwhite populations, Fitzpatrick skin types IV–VI, various ethnic populations and regions with these populations.
Of the 168 papers, 104 lacked data contributing to SOC rosacea patients and adjunctive skincare use, leaving 64 articles for further review. After removing 14 duplicate articles, 50 remained; however, the small number of clinical studies on skincare using cleansers and moisturizers as an adjunct to treatment and maintenance for SOC patients with rosacea did not allow for a systematic literature review and grading of the evidence.
Development of Statements
During the meetings workshop, the panel members discussed the recommendations on rosacea treatment in SOC patients and skincare given in clinical studies, clinical guidelines, consensus papers, and algorithms available per region with different racial/ ethnic populations. Drawing from fourteen draft statements, the advisors agreed on five statements for insights and recommendations on treating cutaneous features of rosacea in SOC populations.
Rosacea Occurrence in Various Ethnic Populations
Statement 1: Although data are limited, studies and anecdotal clinical experience suggest that rosacea is more common in individuals with darker skin than previously reported.
Currently, data on nonwhite rosacea patients are limited.
Earlier data from 1935 and the 1980s comprises small-size case studies and are therefore not included in the discussion. Recent studies and anecdotal clinical experience suggest that rosacea is more common in individuals of African ancestry with richly pigmented skin than previously reported. A 1993-2010 US National ambulatory medical care survey on the racial/ethnic distribution of patients with rosacea showed that 2% of rosacea patients were Black, and 2.3% of clinicians believed that rosacea does not occur in people with SOC.8,19-21
A 5-year longitudinal cohort study of 705 rosacea patients included 421 (16.27%) African-American and 284 (10.98%) other SOC rosacea patients on North Carolina Medicaid. In this study, physicians prescribed at least one topical rosacea treatment (metronidazole, adapalene, azelaic acid, permethrin, or sulfacetamide).9
Various publications, including the treatment and maintenance of rosacea SOC patients, showed that rosacea might be less common in deeply pigmented patients than in White populations but is not rare.8,10-14,19-22
