Authored by a who’s who of Rosacea Experts, the National Rosacea Society has again brought about a publication that puts a stake in the ground for rosacea treatment and management.
Briefly some history: In 2002, the National Rosacea Society Expert Committee reported on a standard classification system that identified primary and secondary features of rosacea and described 4 common patterns of signs and symptoms designated as subtypes. In 2004, the committee published a standard grading system for assessing the relative severity of rosacea to enhance the utility of the classification system for researchers and clinicians.
As we have always known, the classification system for rosacea is provisional and based on what can be observed rather than any common understanding of what causes rosacea (pathogenesis) or assumed progression of symptoms between the defined subtypes.
Now, the committee has developed standard management options for rosacea. The committee was expanded to include additional experts in dermatology, skin care, laser therapy and ophthalmology.
Many of the rosacea experts credited as authoring this paper have links to pharmaceutical companies, and their links are listed. Interestingly Dr. Wilkin is listed as “a scientific and regulatory affairs consultant for 145 companies, including some that products for rosacea.” Wow that is a lot of consulting !
See also Standard Management Options 2: according to subtype.
My Review
Below is a summary of the 2009 Standard management options for rosacea, part 1. I have given a quick view of each section. For further details, including several disclaimers about the information supplied, see the full text of the paper. The PDF can be purchased for $5 online at cutis.com. I can also email a copy if you would like to read a copy for your own rosacea treatment.
The committee is emphasizing the importance of how lifestyle changes and skincare and understanding the particular role of a treatment to achieving the best results for an individual patient.
The standard management options are a menu, you aren’t meant to do them all, just pick and choose what is relevant for your symptoms.
Medical History
A medical history is seen as necessary as some features of rosacea may not be visible when you front up at a doctor’s surgery. Also some tricky alternative diagnoses must be eliminated first.
A few paragraphs are very similar to that Dr. Powell says in his book Rosacea Diagnosis and Management, Frank C. Powell. eg. sun sensitive skin as in heliodermatitis can be confused with the redness and broken blood vessels (ETTR) or rosacea. Undiagnosed ocular involvement is another reason for a detailed medical history.
Drug Therapy
The papules and pustules of rosacea can be effectively treated by well known drugs like Finacea and Oracea which have been officially approved by the FDA for treating rosacea. Options for off-label medications will be detailed in Part 2 of this series.
The committee acknowledges the need for research into and treatments for the background redness of rosacea as this is a great unmet clinical need.
Laser and Light Therapy
Most lasers that treat the vascular component of rosacea have wavelengths in the 500-600nm range. Also mentioned also is long-pulsed dye lasers, the 532nm KTP laser along with IPL. The er:YAG and 10,600nm CO2 ablative lasers are also given a mention for subtype 3 of rosacea.
Lifestyle Management
This is the bit of rosacea therapy that always seems wanting to me. The committee is suggesting that rosacea sufferers keep a record of or try to avoid their triggers. This just seems so impractical for real life.
Adjunctive Care
Skin Care is an important component of rosacea management because of the sensitive and easily irritated nature of rosacea skin. If chemical sunscreens cause irritation, physical sunblocks using zinc or titanium dioxide are recommended.
As stinging most often occurs when the skin is wet, rosacea sufferers are advised to apply wait 5 – 30 minutes for the face to dry after gentle cleansing, before applying topicals.
Avoid any product that causes burning, stinging itching etc. Good advice, but may be quite hard to follow if one cannot find the perfect moisturiser or cleanser for their regime.
“New cosmetics should be regularly purchased to minimize microbial contamination and degradation”. That advice sounds expensive !
Conclusion
Overall there is little here that is new to most rosacea sufferers. This paper does though serve well as a starting point when trying to find a regime that will relieve your symptoms.
Certainly the weight of authors involved in this paper will go a long way to help convince your doctor that the advice herein is well heeded.
Those interested in a more thorough treatment of up to date rosacea treatment and diagnosis may be interested in my Book Review: Rosacea: Diagnosis and Management, Frank C. Powell which was written by one of the expert authors of this paper.
Standard management options for rosacea, part 1: overview and broad spectrum of care.
Cutis. 2009 Jul;84(1):43-7.
Odom R, Dahl M, Dover J, Draelos Z, Drake L, Macsai M, Powell F, Thiboutot D, Webster GF, Wilkin J; National Rosacea Society Expert Committee on the Classification and Staging of Roasacea. ( <- yes pubmed does indeed mis-spell rosacea!)
The standard management options were developed by a consensus committee and review panel of 26 experts to assist in providing optimal patient care based on the standard classification and grading systems for rosacea that were developed to perform research; analyze results and compare data from different sources; and provide a common terminology and reference for the diagnosis, treatment, and assessment of results in clinical practice. We discuss standard management options for rosacea in 2 parts: (1) overview and broad spectrum of care, and (2) options according to subtype. The options are considered provisional and may be expanded and updated as appropriate. Managing the various potential signs and symptoms of rosacea calls for consideration of a broad spectrum of care, and a more precise selection of therapeutic options may become increasingly possible as the mechanism of action of therapies are more definitively established.
4 comments ↓
Hello David
It’s compiled by a who’s who of Rosacea Experts? I’m very wary of the term “rosacea expert” but I assume these are primarily dermatologists? You have mentioned a couple of names but do you know who the others are?
I was fortunate to see a dermatologist who I rate as one of the best, especially with rosacea but it might help others to have a list of names and locations of the physicians with an interest in and a proven track record of treating rosacea. As we know there are a few quacks around so maybe a directory of those recognised in the medical world as proven “experts” in this particular area would be very useful for many people looking for the best treatment options.
Regards
Peter
Hi Peter,
Below is the list of experts who were involved in these 2 papers. There is of course no suggestion on my part that the authors see patients and would be helpful in a clinical setting, but nonetheless to have a history of publishing papers we know that they are the peak of the field of Dermatology.
Sadly it is still the case that rosacea sufferers need to start their quest for relief by accessing a good doctor. A false step by visiting the wrong web sites for information or visiting a doctor with no experience will make that task all that much harder.
Jeffrey Dover, MD, is from the Department of Dermatology, Yale University, New Haven, Connecticut.
Zoe Draelos, MD, is from Dermatology Consulting Services, High Point, North Carolina.
Lynn Drake, MD, is from the Department of Dermatology, Harvard University, Boston, Massachusetts.
Marian Macsai, MD, is from the Department of Ophthalmology, Northwestern University, Chicago, Illinois.
Frank Powell, MD, is from the Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland.
Diane Thiboutot, MD, is from the Department of Dermatology Research, Penn State University, Hershey.
Guy F. Webster, MD, PhD, is from the Department of Dermatology, Thomas Jefferson University, Philadelphia, Pennsylvania.
Jonathan Wilkin, MD, is from the National Rosacea Society Medical Advisory Board, Barrington, Illinois.
Additionally, the following are thanked for their contributions and reviewing the paper;
davidp.
Thanks for the list David – it might help those who are looking for “experts” and not fall into the hands of the “quacks” out there.
I would hope that these people know what they are talking about but there is very much an American bias there and it would be good to have seen more Europeans contributing, plus what about your part of the world?
I recognise a couple of names there but surprised with the American bias that Larry Millikan MD wasn’t involved. I have read a couple of his rosacea articles and they were very good – I posted one up on your RSC Forum called “The Red Menace”.
There certainly is a north america bias in the list of contributors – but I assume that is because the number of universities, schools, dermatologists, PhD students etc. is far far greater that any other country.
It is nice to see Dr. Powell as a senior researcher and clinician as a European. From a small city like Dublin too.
Here in Perth we have Dr. Drummond and also Daphne Su who I think has written the first PhD on rosacea.
Would be great to see more and more from all around the world.
I wonder how we encourage this ?
davidp.
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