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 !
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.
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.
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.
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.
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 !
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.
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.