PracticalDermatology

Dermatologists who treat acne and rosacea find themselves in between awareness months, with the April focus on rosacea and attention shifting to acne in June. Although much of the emphasis during disease awareness months is on informing the general public, there are opportunities for dermatologists themselves to enhance their understanding of these common skin diseases, their impact on patients, and their treatment. Leading dermatologists have identified key ways that prescribers can increase awareness and improve treatment outcomes.

Awareness of Antibiotic Stewardship

The need for responsible use of antibiotics requires ongoing emphasis. In fact, the Centers for Disease Control and Prevention (CDC) calls antimicrobial resistance “an urgent global public health threat.” The health authority says that more than 2.8 million resistant infections occur in the US each year.1

In the US, dermatologists have and continue to lead in antibiotic use, prescribing more antibiotics per clinician than any other medical specialty.2 “We prescribe antibiotics for rosacea, acne, and numerous other dermatologic diseases as well as for patients undergoing surgery. However, concerns about antibiotic resistance require us to thoughtfully assess our use of these important agents,” says American Acne and Rosacea Society (AARS) President-Elect James Q. Del Rosso, DO.

The AARS established the Scientific Panel on Antibiotic Use in Dermatology (SPAUD) to address the responsible use of antibiotics. “We stay on top of the information that’s coming out and the information that was previously published as best as possible so that we utilize antibiotics appropriately and make sure that we’re giving our patients the best possible care,” Dr. Del Rosso says.

“There is a role for antibiotics, but prescribers should always be looking at other modalities and not just reflexively be prescribing the same way we’ve done things over and over again. It is important for the field of dermatology that we continue to progress and to develop better treatments,” he adds.

Guidelines of care for acne and rosacea emphasize strategies for the responsible use of oral antibiotics. (See sidebar for a summary of strategies endorsed by SPAUD. More information is available at acneandrosacea.org.)

Awareness of Patient Needs

More than 14 million Americans have rosacea,3 and the condition is associated with potentially negative impacts on the quality of life of affected individuals.4 Yet, according to Hilary Baldwin, MD, a founding member and past president of the AARS, “Many patients with rosacea don’t even realize that they have a diagnosable skin condition.” She urges patients concerned about skin symptoms to visit the office of a board-certified dermatologist and advises dermatology health care professionals to ask about visible symptoms if the patient doesn’t mention them. “I think it’s very important for people to recognize their own disease,” Dr. Baldwin adds.

I view Rosacea Awareness Month and Acne Rosacea Month as ideal times to remind patients, as well as prescribers, that it is possible to achieve good control of either disease with today’s available treatment options. When I ask fellow dermatologists how many zits it takes to have a negative impact on their day, overwhelmingly, the most common answer I hear is, "One." If we don’t want even one acne lesion on our face, neither do our patients.

Don’t dismiss patients who have had a good response to treatment but express ongoing dissatisfaction with outcomes. We need to hear what patients are expressing to us. Those of us who are writing the prescriptions need to keep going and help our patients to achieve clear skin.

Similarly, when treating rosacea, we should focus on prescribing combinations of treatments that will give patients the best control possible of their disease.

Awareness of Misinformation

Dermatologists know that misinformation about acne and rosacea is common. But with the rate at which home remedies and questionable interventions are shared on social media, simply ignoring the problem may not be effective. Instead, clinicians should take time to advise patients on the science behind prescription therapies while providing at least general caution against non-medical advice.

Throughout June, AARS will take to social media to address some of the most common TikTok trends (such as applying apple cider vinegar or table salt to the face) and urging patients to visit the office of a board-certified dermatologist.

“Everyone is always looking for a spot treatment for acne,” observes AARS member Lawrence Green, MD. “Those spots are mounds of inflammation. We don’t want to put an irritant on the face. We want to reduce the inflammation. It’s important that patients see a board-certified dermatologist so that we can recommend anti-inflammatory medications.”

1. About Antimicrobial Resistance. Centers for Disease Control and Prevention. Accessed May 8, 2023. https://www.cdc.gov/drugresistance/about.html.

2. Outpatient Antibiotic Prescriptions — United States, 2013. Centers for Disease Control and Prevention. Accessed April 10, 2023. https://www.cdc.gov/antibiotic-use/community/pdfs/Annual-ReportSummary_2013.pdf.

3. Rosacea: Who Gets and Causes. American Academy of Dermatology Association. Accessed April 28, 2023. https://www.aad.org/public/diseases/rosacea/what-is/causes

4. Yang F, Zhang Q, Song D, Liu X, Wang L, Jiang X. A cross-sectional study on the relationship between rosacea severity and quality of life or psychological state. Clin Cosmet Investig Dermatol. 2022;15:2807-2816. Published 2022 Dec 20. doi:10.2147/CCID.S390921