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

have not yet been studied.⁶ Moreover, disruption of the healthy skin microbiome may be of pathological significance.^16-20 The resulting dysbiosis could be a pathological driver of rosacea or a response to changes in the skin microenvironment resulting from rosacea.^16-20

Skin barrier dysfunction is addressed by using skincare, including gentle cleansers and moisturizers, recommended before and during prescription therapy and for maintenance improvement.⁶ To maximize rosacea patient outcomes, an expert panel of dermatologists (advisors) who treat patients with rosacea developed a clinical treatment and maintenance algorithm focusing on the use of over-the-counter (OTC) products, skincare, and sun protection.

The US Cutaneous Rosacea Outcomes (USCRO) Project
The current algorithm represents part II of a series investigating similar topics associated with the prevention, treatment, and maintenance of rosacea.⁶ A previously published review by the USCRO (US Cutaneous Rosacea Outcomes) group on skin barrier deficiency in rosacea and the integration of OTC products and skincare recommended for rosacea treatment and maintenance informed the development of the current algorithm.⁶ The USCRO advisors' publication included the results of a literature review and a survey coupled with the advisor's expert opinion and experience.⁶ The advisors agreed OTC products and skincare play an important role in improving skin barrier function and rosacea symptomatology.⁶ However, further exploration of clinical aspects of OTC product use and heir specific ingredients of interest is required to integrate this knowledge into the current algorithm.⁶

The same group of dermatologists who previously published the USCRO review paper⁶, developed, discussed, and reached a consensus on an evidence-based clinical treatment and maintenance algorithm focusing on rosacea phenotypes. The foundational measures for all rosacea patients during treatment and maintenance include behavioral modification, OTC skin care measures, and skincare regimens including hygiene, moisturization, and sun protection measures and products.⁶ The USCRO algorithm aims to improve patient outcomes and determine the best approach for all US healthcare stakeholders' rosacea treatment and maintenance programs.

The process entailed preparing the project, selecting the advisors, conducting systematic literature searches, summarizing the literature search results, grading the literature, and drafting the algorithm. The advisors used a modified Delphi approach following the AGREE II instrument in the algorithm's development.^21,22 The modified Delphi method is a communication technique for medical project interactive decision-making.²² The process was adapted from face-to-face meetings to a hybrid model. The face-to-face discussion was followed by an online follow-up, replacing a questionnaire.²²