Targeted rosacea therapies can lead to facial skin free of redness and blemishes, but only if these two key elements are also in place: the patient’s commitment to consistent adherence to the treatment plan and the patience to let it work. The National Rosacea Society (NRS) has designated April as Rosacea Awareness Month to educate the public on this conspicuous, life-disruptive facial disorder affecting 16 million Americans, and urge those who may have it to see a dermatologist for diagnosis and therapy tailored to their individual case.
“Patients play a vital role in managing their rosacea,” said Dr. Steven Feldman, professor of dermatology, pathology, and social sciences and health policy at Wake Forest University School of Medicine. “The combination of signs and symptoms in any individual is often unique, and while physicians take the lead in designing an appropriate treatment plan, sufferers bear equal responsibility for their part: being diligent and patient in using their medication.”
Rosacea is a complex disorder with a broad range of potential manifestations. Although it can develop in many ways, rosacea typically first appears after age 30 as a transient redness on the cheeks, nose, chin or forehead that might be mistaken for a sunburn. The redness tends to worsen and grow more persistent over time, and small visible blood vessels may appear. Without treatment, bumps and pimples often develop, and burning and stinging are common. In severe cases, the nose may become enlarged from excess tissue, and in many rosacea patients the eyes are also affected, feeling irritated and appearing watery or bloodshot.
Rosacea’s signs and symptoms can vary widely, and the chronic disorder was initially classified into four subtypes – clusters of observable manifestations that often appeared together. However, with the growth of rosacea research in the last 20 years, it has become clear that rosacea’s often fluctuating and seemingly unrelated signs and symptoms are part of a single underlying inflammatory continuum.
The disease is now identified and treated according to its individual characteristics, or phenotypes – the major elements that may result from this disease process, which may appear in different combinations and at different times. This new targeted focus encourages consideration of the full range of potential signs and symptoms and better assessment of their severity.
Treatment Takes Time and Commitment
Fortunately, research has likewise uncovered increasingly sophisticated therapies that address the specific phenotypes, and a unique treatment plan precisely tailored for each individual case may be devised from this menu of medicines. However, depending on the phenotypes present and their severity, the timelines to remission may vary.
In a recent survey, the NRS asked rosacea patients how long they gave a new product or treatment to work before giving up on it.1 Over 75% said within a month, and more than half said two weeks or less. In contrast, dermatologists recommend sticking with a new therapy for at least 12 weeks before evaluating its effectiveness. One study showed that 28% of rosacea patients took time off their treatment regimen, but Dr. Feldman noted that actual nonadherence rates may be higher. Reasons for quitting treatment or using it incorrectly may include believing signs and symptoms had resolved, affordability and insurance issues, and believing the medicine was ineffective, he said.2
Dr. Feldman stressed that the patients must be proactive in partnering with their physicians, and this involves managing their own behavior to establish consistent routines.
“Adherence is important through the whole course of therapy, but patients have to make a concerted effort to use the treatment faithfully in the first week or two especially. In this way they get into the habit of using the medicine, and they’ll see the benefits of the drug,” he said. “Also, it’s easy to convince yourself to do something for one week rather than eight, so just telling yourself, ‘This week I’m going to do a really good job of taking my medicine’ can be a big step forward.”
Often older patients who are accustomed to taking a variety of medicines already have organizational tools like pill cases and calendar reminders, he noted.
“Patience and consistency are imperative,” he said. “It can be a vicious cycle – if patients don’t use therapy well, it may be slow to work, and physicians may therefore believe the therapy is inappropriate or ineffective.”
How is Rosacea Diagnosed and Treated?
Rosacea may be diagnosed in several ways: when either persistent redness of the facial skin or skin thickening (phymatous changes) are present; or when two or more other major signs appear together, including bumps and pimples, flushing, small visible blood vessels or eye irritation such as burning, stinging or redness.
Individuals with any of the following warning signs of rosacea are urged to see a dermatologist for diagnosis and appropriate treatment:
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Redness on the cheeks, nose, chin or forehead
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Bumps or pimples on the face
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Small visible blood vessels on the face
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Watery or irritated eyes
In addition to achieving clear skin, optimal therapy may keep the disease from progressing, as some medications appear to improve baseline redness over time, while others have been shown to help maintain remission of inflammatory bumps and pimples.3
A combination of therapies may also have a synergistic effect on improving other signs and symptoms. For example, one study found that combining a topical alpha agonist for redness with a topical anti-inflammatory therapy for bumps and pimples achieved significantly better reduction of both phenotypes when the two drugs were used at the same time.4
In addition to medical therapy, doctors will also offer advice on lifestyle changes necessary to keep signs and symptoms at bay, including identifying and avoiding the patient’s personal trigger factors that may exacerbate the disorder. Common rosacea triggers include sun exposure, emotional stress, hot or cold weather, wind, heavy exercise, alcohol, spicy foods, heated beverages, humidity, certain skin care products and potentially an overabundance of Demodex mites.
Dermatologists recommend using only gentle, non-irritating skin care products and cosmetics on the face, as well as the daily use of sunscreen.
Rosacea also carries a psychological burden. A growing accumulation of data shows that persistent facial redness (erythema) has a significant impact on sufferers’ quality of life. In an NRS survey of 1,675 rosacea patients, 82% 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% for those with moderate to severe redness.3
Rosacea has also been linked with serious psychiatric conditions, including anxiety, depression and suicidal thoughts in the rosacea patients compared to those without the disorder.5
“Fortunately, patients may be empowered to learn that they have a significant role in putting their unsightly disorder into remission,” Dr. Feldman said.
During April and throughout the year, people who suspect they may have rosacea can contact the NRS for more information, or visit its website at rosacea.org.
About the National Rosacea Society
The National Rosacea Society is the world's largest organization dedicated to improving the lives of the estimated 16 million Americans who suffer from this widespread but poorly understood disorder. Its mission is to raise awareness of rosacea, provide public health information on the disorder and support medical research that may lead to improvements in its management, prevention and potential cure.
In addition to the NRS website at rosacea.org, the NRS may be followed on Facebook, Twitter, Instagram and Pinterest for up-to-date information and tips on rosacea. Further information may be obtained by writing the National Rosacea Society, 4619 N. Ravenswood Avenue, Suite 103, Chicago, Illinois 60640; via email at info@rosacea.org; or by calling its toll-free number at 1-888-NO-BLUSH.
References:
1. National Rosacea Society. Patients Need Patience: Give Rosacea Therapy Time. Published Dec. 13, 2022.
2. Kuo S, Huang KE, Davis SA, Feldman SR. The rosacea patient journey: a novel approach to conceptualizing patient experiences. Cutis 2015;95:37-43.
3. Gallo RL, Baldwin HE, Stein Gold L, Harper JC. Update on facial erythema in rosacea. J Drugs Dermatol 2021 Aug 1;20(8):861-864. Published online July 19, 2021. DOI:10.36849/JDD.6062.
4. Gold LS, Papp K, Lynde C, et al. Treatment of rosacea with concomitant use of topical ivermectin 1% cream and brimonidine 0.33% gel: a randomized, vehicle-controlled study. J Drugs Dermatol 2017;16(9):909–916.
5. Lukaviciute L, Ganceviciene R, Navickas P, et al. Anxiety, depression, and suicidal ideation amongst patients with facial dermatoses (acne, rosacea, perioral dermatitis, and folliculitis) in Lithuania. Dermatology 2020;236(4):314-322.