Supplement Article: Skin Barrier Deficiency in Rosacea: An Algorithm Integrating OTC Skincare Products Into Treatment Regimens

September 2022 | Volume 21 | Issue 9 | SF3595563 | Copyright © September 2022


Published online September 2, 2022

Hilary E. Baldwin MDa, Andrew F. Alexis MD MPHb, Anneke Andriessen PhDc, Diane S. Berson MD FAADd, Julie Harper MDe, Edward Lain MD FAADf, Shari Marchbein MDg, Linda Stein Gold MD FAADh

aAcne Treatment & Research Center, Brooklyn, NY
bClinical Dermatology, Weill Cornell Medical College, New York, NY
cRadboud UMC Nijmegen, Andriessen Consultants, Malden, The Netherlands
dWeill Medical College of Cornell University, New York-Presbyterian Hospital, New York, NY
eThe Dermatology and Skin Care Center of Birmingham, Birmingham, AL
fSanova Dermatology, Austin TX; Austin Institute for Clinical Research, Austin, TX
gNYU School of Medicine, New York, NY
hHenry Ford Health System, Detroit, MI

Abstract
Introduction: Rosacea is a chronic condition involving inflammation leading to a diminished skin barrier function in sebaceous gland-rich facial skin. The current algorithm represents part II of a series investigating similar topics associated with preventing, treating, and maintaining rosacea, including ceramides-containing skincare.
Methods: The consensus process consisted of a modified Delphi technique. A previously published review by the US Cutaneous Rosacea Outcomes (USCRO) group on skin barrier deficiency in rosacea and the integration of over-the-counter (OTC) products and skincare recommended for rosacea treatment and maintenance informed the development of the current algorithm. The selected information from the literature searches, coupled with the USCRO group's opinion and experience, was used to develop, discuss, and reach a consensus on an evidence-based clinical treatment and maintenance algorithm focusing on rosacea phenotypes.
Results: The algorithm includes foundational measures to be taken by all patients with rosacea and rosacea-prone skin. These measures include education, behavioral modifications, avoidance of triggers and skin irritants, preventative skincare, and sun avoidance and sunscreen use. The algorithm further describes how assessment of skin condition and grading of cutaneous rosacea should take place during treatment and maintenance while the preventative measures continue.
Conclusions: Prescription medications combined with gentle cleansers, moisturizers, and sunscreen support a successful rosacea therapy.

J Drugs Dermatol. 2022;21:9(Suppl 1):s3-10.

INTRODUCTION

Rosacea is a common relapsing facial skin condition most prevalent in Caucasian women from the Northern hemisphere, although this is likely due to reporting bias.1,2 Historically, rosacea has been considered uncommon in richly pigmented skin, but recent reports highlight rosacea in other skin phototypes including in Asian and African populations.2,3

Genetic factors play a clear but ill-defined role in the development of rosacea.2,3

Rosacea's pathophysiology is not entirely understood.

However, dysregulation of the immune system and nervous and vascular systems changes have been identified.1,3,4 Rosacea is characterized by inflammation and vasculopathy and presents with pruritus, burn, and sting symptoms and an increased incidence of irritant and allergic contact dermatitis.1,4-6 Chronic inflammation leads to a diminished skin barrier function in sebaceous gland-rich facial skin affected by rosacea.7-9 Clinical studies in rosacea patients have shown increased transepidermal water loss (TEWL), reduced skin hydration, elevated skin surface pH, and increased lactic acid stinger reaction indicating skin barrier deficiency in rosacea.6,10-16 However, specific lipid abnormalities in rosacea-prone skin
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