PracticalDermatology

More than 16 million Americans live with rosacea, according to the National Rosacea Society. This condition can have dramatic effects on self-esteem. The good news is that today’s treatments are better than ever before. By tailoring treatments to rosacea subtypes, dermatologists can reduce visible signs of this condition and improve quality of life for their patients. Zoe Diana Draelos, MD, a dermatologist in High Point, NC, and a Consulting Professor of Dermatology at Duke University in Durham, spoke to Practical Dermatology® magazine about how advances in diagnosing and treating rosacea are playing out at the bedside.

How has our understanding of rosacea changed?

Zoe Diana Draelos, MD: Rosacea is probably many diseases that had been lumped under the same hat. The four index findings include facial redness, papulopustular rosacea, phymatous rosacea, and ocular rosacea.

The question is do these four index findings represent the same disease process or are they different? The new National Rosacea Society classification system speaks to the fact that rosacea has a breadth of findings, all of which can be exhibited in the same patient. A patient may exhibit all of these symptoms or just one, and rosacea can also progress to include other symptoms over time.

How does rosacea affect quality of life for your patients?

Dr. Draelos: Rosacea patients are very self-conscious, especially if they flush or turn red in the middle of a meeting or presentation. Many of the Phase 3 studies administered quality of life surveys and found that treatment did improve self-esteem. The FDA is mandating more of these surveys because they want to know that what the doctor sees as an improvement is meaningful in the patients eyes as well.

What is new and exciting in the treatment of rosacea?

Dr. Draelos: There are new medications on the horizon for rosacea. Benzoyl peroxide is a very potent antibacterial agent that has been on the market for acne, but was always thought to be too irritating to use on the faces of patients with rosacea. A creative new formulation of microencapsulated 5% benzoyl peroxide that is released over time can now be used in rosacea. This is a prescription medication. The new technology is the microencapsulation with silicone, which is not approved for over-the-counter use. It is currently only approved for acne.

The other exciting new treatment is topical minocycline, which is available as a foam and a mineral-based gel. Both forms look promising for rosacea. It’s a little different than most topicals in that yellow is the color of the drug. This doesn’t mean it’s spoiled. These medications are for reducing inflammatory lesion count, but when we treat the papules and pustules of rosacea, the redness might get better too. Topical minocycline is not FDA approved for rosacea. Approval of Foamix’s topical minocycline foam for rosacea is expected in June 2020.

How do you decide which treatments to use in which patients?

Dr. Draelos: Symptoms dictate treatment. Ocular rosacea needs oral antibiotics, but for red bumps and blush, a topical is probably appropriate. If the redness is episodic and they don’t have other manifestations, we can use topical vasoconstrictors such as Mirvaso (brimonidine) and Rhofade (oxymetazoline). These provide a time-limited effect. Microencapsulated 5% benzoyl peroxide and topical minocycline, however, may provide long-term improvements in inflammatory lesion count. These medications can be used together to address papules, pustules and the redness of rosacea.