Advances in our understanding of rosacea will help patients

Rosacea is a skin condition that affects the face, specifically the forehead, nose, cheeks, and chin.^1,2 Patients often require lifelong rosacea treatment to minimize symptoms. The skin appears red and irritated, with small blood vessels and sometimes small pimple-like bumps (papules and pustules) visible on the face.^1,2 Cutaneous swelling (known as phymas) and eye irritation may also develop.^1,2About 16 million people in the US have rosacea, which is more common in women than in men.^1,2 Although rosacea is more common in people with fair skin, it can develop in any skin type.^1,2

Subtypes of rosacea

Rosacea is clinically divided into four subtypes that may appear together.² 

1. Erythematotelangiectatic rosacea (vascular rosacea): This subtype is characterized by vascular symptoms including flushing, erythema, and telangiectasia.^1,2 Stinging and burning sensations may also develop.^2,3 This is the most difficult subtype to treat.¹  
2. Papulopustular rosacea (inflammatory rosacea): This subtype is mainly characterized by inflammatory lesions that are similar to acne vulgaris but are usually painless.^1,2 The skin also appears red and is more sensitive.^1,3
3. Phymatous rosacea: In this subtype, the skin thickens and appears irregular and with apparent nodules.^1,2,3 Symptoms mainly involve the nose (rhinophyma) but could also involve other parts of the face including the ears.^1,2 This subtype is more common in men.¹ 

Ocular rosacea: Symptoms in this subtype include red, irritated eyes, including the eyelids and the conjunctiva.^1,2 Patients may also develop burning and stinging sensations in the eyes, sensitivity to light, and blurred vision.^1,2,3 It is estimated that 60% of patients with rosacea develop ocular symptoms.¹

Rosacea impacts patients’ quality of life

Rosacea can impact patient’s self-esteem, social interactions, and other aspects of their quality of life.¹ This is especially true because the symptoms appear on highly visible areas of the face and are chronic or sometimes life-long.¹ 

Anxiety and depression are also common among patients with rosacea.^1,2 Studies have also shown that significant improvements in Dermatology Life Quality Index (DLQI) scores are seen after successful rosacea treatment.¹

Rosacea treatment updates

Rosacea is a chronic disease, and treatments are applied with the goal of minimizing rosacea signs and symptoms. Available treatments include topical treatments, systemic therapies, and procedures (such as laser and light treatments).^1,2,3 

A new clinical practice guideline for rosacea was published by the British Association of Dermatologists in May 2021.² It includes updates regarding the clinical effectiveness of available rosacea treatments.² 

The updated rosacea treatment guideline recommends the use of topical treatments such as metronidazole and azelaic acid for papulopustular rosacea.² In severe cases, oral antibiotics such as tetracyclines, can be used; if that fails, a low dose of isotretinoin should be considered.² Laser and light treatments, oral propranolol, and topical brimonidine are recommended for erythematotelangiectatic rosacea.² 

For phymatous rosacea, the guideline recommends laser ablation or surgical intervention.² For ocular rosacea, general management of eye dryness and irritation are recommended; this can include avoiding environments and medicines that cause dryness, using lubricants and warm compresses, and massaging and cleaning the eyelids.²

The rosacea treatment guideline also recommends that physicians consider the mental toll of rosacea on the patient and refer patients for psychological evaluation if needed.²  

Patients may require more than one treatment method to adequately manage their symptoms.^4,5 Available treatment options may not work for all rosacea subtypes; thus, there is a need for new treatment approaches and a better understanding of rosacea pathophysiology to improve patient outcomes.^1,4 

New rosacea treatment approaches

Sarecycline is a third-generation tetracycline antibiotic, approved by FDA to treat acne- tends to have fewer side effects than some other tetracyclines. A pilot study of oral sarecycline in 102 patients with rosacea showed good efficacy in patients with papulopustular rosacea; the drug was also well-tolerated.⁵ Unlike the commonly used oral tetracyclines, sarecycline is a narrow-spectrum antibiotic and the development of antibiotic-resistant bacteria might be minimized with its use.⁵