Although rosacea presentation in SOC may differ, the overall approach to medical therapy is similar to those with lighter skin phototypes and comprises anti-demodex, anti-inflammatory, and anti-angiogenesis treatment modalities (Table 1).6,7,22,23,32-37
For safety reasons, the use of energy-based devices for rosacea varies according to skin phototype, with vascular lasers and intense pulse light generally being limited to Fitzpatrick skin phototypes I-IV. Clinical data involving rosacea patients with SOC and their treatment and maintenance are limited.6 The assumption that treating SOC rosacea populations is similar to White patients is based on clinical experience, rosacea guidelines, and consensus papers from various regions. 6,7,22,23,32-37
Patient education about the chronic nature of the disease, its long-term control, and management is essential for successful outcomes and helps patients set goals and manage expectations (Box 1).6,7,22,23,32-37 Prompt, and persistent erythema and inflammation reduction are important in the clearance or reduction of papules and pustules and the mitigation or avoidance of post-inflammatory hyperpigmentation.6,7,22,23,32-37
General measures must include preventing exposure to triggering factors avoiding compromising the skin barrier and vasodilatation.6,7,22,23,32-37 Lifestyle choices include sun avoidance and the use of sunblock.32-37 General measures further comprise promoting a healthy skin barrier reducing cutaneous symptoms and sensitive skin reactions.6,7,22,23,32-37
The skin barrier function includes physical, chemical, and immunological aspects to protect against harmful environmental factors to prevent their ingress.38 The skin pH plays an important role in the barrier function. A healthy barrier function depends on stratum corneum pH complex interplay, and exogenous and endogenous processes38 Lipid processing and the formation of lamellar structures require an acidic skin pH.38 Elevated skin pH may delay barrier recovery and facilitate skin barrier breakdown.38 This process is particularly well documented in AD, but also rosacea.25-29
A retrospective case-control survey of 997 Chinese rosacea patients and 1012 skin-healthy controls showed that low facial skin tolerance to skin care such as facial masks and harsh cleansers might cause facial allergic reactions in rosacea patients.31
Another Chinese retrospective case-controlled survey of 1,245 rosacea cases and 1,538 healthy controls found a close correlation to the development of rosacea and excessive use of a facial cleanser (twice or more a day) and a facial mask (more than four times a week).39 The study noted that frequent makeup use (more than six times a week), regular beauty salon treatments (more than once a week) and using beauty salon products were associated with rosacea development. The researchers further found a negative correlation with rosacea in subjects using moisturizing products (OR = 0.602, 95%CI 0.386–0.983, P=.035) and sunscreen (OR = 0.303–0.507, P<.001 or P=.0167).39
Statement 5: Educate SOC rosacea patients on the importance of:
• Avoidance of triggers • Using gentle cleansers
• Avoiding skincare products with elevated pH
• Avoiding excessive cleansing and exfoliating
• Frequent use of quality moisturizers
• Choosing skincare that promotes a healthy barrier
• Using mineral sun protection with SPF ≥ 30
Education of rosacea patients on avoiding triggers is an essential measure addressed in various guidelines, pathways, and consensus papers.23,32-34
For safety reasons, the use of energy-based devices for rosacea varies according to skin phototype, with vascular lasers and intense pulse light generally being limited to Fitzpatrick skin phototypes I-IV. Clinical data involving rosacea patients with SOC and their treatment and maintenance are limited.6 The assumption that treating SOC rosacea populations is similar to White patients is based on clinical experience, rosacea guidelines, and consensus papers from various regions. 6,7,22,23,32-37
Patient education about the chronic nature of the disease, its long-term control, and management is essential for successful outcomes and helps patients set goals and manage expectations (Box 1).6,7,22,23,32-37 Prompt, and persistent erythema and inflammation reduction are important in the clearance or reduction of papules and pustules and the mitigation or avoidance of post-inflammatory hyperpigmentation.6,7,22,23,32-37
General measures must include preventing exposure to triggering factors avoiding compromising the skin barrier and vasodilatation.6,7,22,23,32-37 Lifestyle choices include sun avoidance and the use of sunblock.32-37 General measures further comprise promoting a healthy skin barrier reducing cutaneous symptoms and sensitive skin reactions.6,7,22,23,32-37
The skin barrier function includes physical, chemical, and immunological aspects to protect against harmful environmental factors to prevent their ingress.38 The skin pH plays an important role in the barrier function. A healthy barrier function depends on stratum corneum pH complex interplay, and exogenous and endogenous processes38 Lipid processing and the formation of lamellar structures require an acidic skin pH.38 Elevated skin pH may delay barrier recovery and facilitate skin barrier breakdown.38 This process is particularly well documented in AD, but also rosacea.25-29
A retrospective case-control survey of 997 Chinese rosacea patients and 1012 skin-healthy controls showed that low facial skin tolerance to skin care such as facial masks and harsh cleansers might cause facial allergic reactions in rosacea patients.31
Another Chinese retrospective case-controlled survey of 1,245 rosacea cases and 1,538 healthy controls found a close correlation to the development of rosacea and excessive use of a facial cleanser (twice or more a day) and a facial mask (more than four times a week).39 The study noted that frequent makeup use (more than six times a week), regular beauty salon treatments (more than once a week) and using beauty salon products were associated with rosacea development. The researchers further found a negative correlation with rosacea in subjects using moisturizing products (OR = 0.602, 95%CI 0.386–0.983, P=.035) and sunscreen (OR = 0.303–0.507, P<.001 or P=.0167).39
Statement 5: Educate SOC rosacea patients on the importance of:
• Avoidance of triggers • Using gentle cleansers
• Avoiding skincare products with elevated pH
• Avoiding excessive cleansing and exfoliating
• Frequent use of quality moisturizers
• Choosing skincare that promotes a healthy barrier
• Using mineral sun protection with SPF ≥ 30
Education of rosacea patients on avoiding triggers is an essential measure addressed in various guidelines, pathways, and consensus papers.23,32-34
