Dermatologists should place greater emphasis on persistent facial erythema of rosacea, a panel of experts concludes. Their recommendations, based on a National Rosacea Society (NRS) roundtable conversation, appear in the Journal of Drugs in Dermatology.
“Based on current scientific knowledge and clinical experience, rosacea is now classified as a single disorder with many potential phenotypes that may occur in various combinations, with persistent facial erythema as the primary diagnostic sign,” says Dr. Richard Gallo, chair of dermatology at the University of California-San Diego, in a statement. He led the roundtable. “Combined with study results 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 should be effectively managed for optimal patient outcomes.”

Recent research has demonstrated that rosacea’s initial redness as well as its other diverse features are likely to be part of a consistent continuum of inflammation, and medical therapies that work to reduce inflammation may be useful in treating this wide range of signs and symptoms. In addition, data collected in NRS surveys as well as in burden-of-illness studies showed that persistent facial erythema, though often dismissed by physicians as a less serious phenotype, has a significant impact on sufferers’ quality of life, often comparable to the impact of eczema, atopic dermatitis and psoriasis. In an NRS survey of 1,675 rosacea patients, 82 percent of those who suffered from erythema reported the condition had a negative impact on their general outlook on life, with the figure rising to 90 percent for those with moderate to severe redness.
In addition to erythema, phymatous changes, though less common, are also designated as diagnostic, and major signs of rosacea include papules and pustules, flushing, telangiectasia and certain ocular manifestations. The presence of any two of the major phenotypes may be considered diagnostic, and secondary phenotypes include burning, stinging, edema and dryness.
Other roundtable participants included Hilary Baldwin, MD, associate professor of dermatology at Rutgers Robert Wood Johnson Medical School; Julie Harper, MD, president and owner of the Dermatology and Skin Care Center of Birmingham; and Linda Stein Gold, MD, director of dermatology clinical research at the Henry Ford Health System.
While rosacea is still treated by some with a monotherapy approach, the roundtable participants agreed that treating every present phenotype with targeted therapies in cooperation with the patients will achieve the best overall outcome, both objectively in terms of clear skin and subjectively in terms of quality of life.
The roundtable was made possible by an educational grant from EPI Health.