New NRS recommendations for rosacea

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An article published in the The Journal of Drugs in Dermatology has offered new recommendations for physicians to pay more attention to erythema associated with rosacea.1

The article was based on a National Rosacea Society (NRS) discussion of this key symptom after the recently updated standard classification system, standard management options, new findings from disease burden studies, and significant advances in care.

The discussion was chaired by Richard Gallo, MD, PhD, president of dermatology at the University of California-San Diego, San Diego, Calif., And included Hilary Baldwin, MD, associate professor of dermatology at Rutgers Robert Wood Johnson Medical School , New Brunswick, New Jersey; Julie Harper, MD, president and owner of Birmingham Center for Dermatology and Skin Care, Vestavia Hills, Alabama; and Linda Stein Gold, MD, director of clinical research in dermatology at the Henry Ford Health System, Detroit, Michigan.

“Based on current scientific knowledge and clinical experience, rosacea is now classified as a single disorder with many potential phenotypes (signs and symptoms) that can occur in various combinations, with persistent facial erythema as the primary diagnostic sign. Said Gallo. “Combined with the results of studies showing the substantial psychological and social impact of facial erythema alone, these important findings have clarified our understanding of how and why all signs and symptoms of rosacea need to be managed effectively for optimal results. the patients. “

If either of the two phenotypes are present (i.e. erythema, thickening of the skin, papules, pustules, flushing, telangiectasias and certain ocular manifestations), they can be considered a diagnosis, according to the article. . Secondary phenotypes include burning, stinging, edema, and dryness.

According to the article, research suggested that the initial redness in rosacea is likely due to inflammation, which can cause other problems, and medications to treat the inflammation may be helpful for treatment. Data collected from NRS surveys as well as from disease burden studies have shown that persistent facial flushing, although often dismissed by physicians as a less severe phenotype, has a significant impact on the quality of life of patients. sufferers, often comparable to the impact of eczema, atopic dermatitis and psoriasis.

In a 2014 NRS survey, out of 1,675 patients diagnosed with rosacea, 82% of those with erythema said the disease had a negative impact on their general outlook on life and it was 90% for those with erythema. who presented with moderate to severe redness.2

The FDA has approved 2 therapies specifically for erythema caused by neurovascular deregulation in rosacea, brimonidine and oxymetazoline, both of which are alpha agonists.

According to research3, while brimonidine works relatively quickly, within 30 minutes some patients complain of excessive skin whitening, and it has been noted that exacerbations of redness can occur. While on the other hand, oxymetazoline has a maximum reduction in erythema at 3 hours, over a 24 hour period then returns to baseline and exacerbation of erythema has not been reported. .3

A combination of therapies can be used to treat different symptoms, such as anti-inflammatory treatments for redness around papules and pustules or light devices to eliminate telangiectasias and reduce erythema. The roundtable agreed that treating current phenotypes with target therapies would achieve the best results instead of using a single method. They also emphasized patient education on adherence, as it may be necessary to avoid triggers, regular use of treatment, and lifestyle changes to properly treat rosacea.

The roundtable was made possible by an educational grant from EPI Health.

Reference:

1. New Publication Tells Doctors About Facial Redness Associated With Rosacea. Rosacea.org. Posted August 23, 2021. Accessed September 13, 2021. https://www.rosacea.org/blog/2021/august/new-publication-updates-physicians-on-facial-erythema-in-rosacea

2. New Rosacea Investigation Shows Emotional Toll Of Face Redness Equals Impact Of Bumps And Pimples | rosacea. Org. Posted January 15, 2015. Accessed September 14, 2021. https://www.rosacea.org/press/2014/january/new-rosacea-survey-shows-emotional-toll-of-facial-redness-equals-impact- de-bumps-pimples

3. Gallo RL, Baldwin HE, Stein Gold L, Harper JC. Update on facial erythema in rosacea. J Drugs Dermatol 2021 August 1; 20 (8). Published online July 19, 2021. Accessed September 14, 2021. DOI: 10.36849 / JDD.6062


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