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Involve patients in treatment decisions to best improve adherence to rosacea treatment

April 11, 2022

3 minute read


Disclosures: Baldwin reports receiving speaker and consulting fees from Almirall, EPI, Galderma and Ortho.

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The National Rosacea Society has designated April as Rosacea Awareness Month, aimed at educating the public about this chronic inflammatory skin condition and its available treatments.

Rosacea is a condition with varying signs and symptoms which, if left untreated, can worsen over time. With more treatment options now available, doctors can personalize care and work with their patients to find the most effective treatment.

The National Rosacea Society has designated April as Rosacea Awareness Month, aimed at educating the public about this chronic inflammatory skin condition and its available treatments.

Healio spoke with Hilary Baldwin, MD, Associate Professor of Dermatology at Rutgers Robert Wood Johnson Medical School, to learn more about available treatment options and the importance of medication adherence.

Helio: What rosacea treatments are currently available?

Baudouin: We have a multitude of treatment options in 2022. Pharmacological treatment choices are based on the particular aspects of the patient’s disease.

For the background erythema of rosacea, Mirvaso (brimonidine, Galderma) and Rhofade (oxymetazoline, EPI Health LLC) do a good job of decreasing daily redness. Many topical medications and one oral medication are available for inflammatory lesions. Depending on the severity of the disease, we may use more than one topical or topical with oral treatment.

Topical medications include Soolantra (ivermectin, Galderma), Zilxi (minocycline foam 1.5%, VYNE Pharmaceuticals Inc.), Finacea (azelaic acid, LEO Pharma), and Metrogel (metronidazole, Galderma). Not only are these drugs effective, but the side effects are rare and mild.

Oracea (doxycycline anti-inflammatory dose, Galderma) is the only FDA-approved oral medication for rosacea. It is effective, unlikely to cause side effects, and does not cause antibiotic resistance associated with full-dose doxycycline. Isotretinoin, although not FDA approved for this indication, is useful for refractory disease.

Additionally, laser and light treatments work well for treating spider veins and reducing the background redness of rosacea. Phymatous tissue can be removed by many physical modalities.

Most patients will have multiple aspects of rosacea: background erythema, telangiectasias, inflammatory lesions and ocular involvement, so combination therapy is the norm.

Helio: Why is it important for patients to adhere to these medications?

Baudouin: Rosacea is a chronic disease that will require chronic treatment. Adhering to the use of medication will result in a more significant resolution of rosacea results. Additionally, it has been shown that patients who use their medication regularly and achieve clear skin (as opposed to just improved skin) may be able to stop using their medication for several months. Some will remain clear indefinitely.

Helio: How can dermatologists ensure patient adherence to medication adherence?

Baudouin: Medication adherence is a challenge with any disease, especially when it is chronic in nature. More than short-term solutions, drugs intended for long-term use must be user-friendly. Using the simplest possible regimen, avoiding tolerance issues, using affordable products, and paying attention to cosmetic elegance will improve the likelihood of regular use.

These requirements underscore the importance of gaining patient adherence to the regimen from the outset.

As clinicians, our job is to strive to resolve all aspects of a patient’s rosacea. However, many patients are bothered by one particular finding (inflammatory lesions or erythema) and not others. Since inflammatory lesions and erythema do not respond to the same drugs, combined disease will require combination therapy, which will complicate the diet.

Before embarking on a therapeutic regimen, it is important to determine which characteristics of the disease are most troublesome for the patient. Inflammatory lesions can be treated with topical or oral medications and many patients have a preference. Erythema can be treated pharmacologically or with laser or light therapy. Giving the patient a say in treatment options can improve adherence.

Helio: What treatment options are being developed?

Baudouin: We will soon be able to prescribe benzoyl peroxide (BPO) to our rosacea patients with inflammatory disease. Historically, BPO has been shown to be effective, but tolerance issues have prevented its use in people with sensitive skin. The new product, Microencapsulated 5% BPO, encapsulates BPO in a porous silica shell. Rather than placing a large bolus of BPO on the skin, small amounts are released over time, resulting in efficacy without irritation.

Helio: Certain rosacea phenotypes cause negative social, emotional, and psychological effects. What are your tips for managing patients’ mental health during treatment?

Baudouin: As clinicians, it is important to treat all aspects of a patient’s illness. Encourage patients to express the negative psychosocial impact of their disease. Referral, if appropriate, to a mental health colleague is often helpful. It may be helpful to remind patients that regular use of their treatment regimen will result in rapid efficacy. Since the disease is chronic, periodic investigations regarding ongoing emotional distress are warranted.

Helio: What else should dermatologists know about adherence to rosacea treatment?

Baudouin: Studies with topical and oral rosacea medications have indicated a difference between clear and nearly clear (or better versus good) results. In clinical trials, the FDA considers “treatment success” to be achieving the state of clear or nearly clear. But in real life, clinicians and patients know the difference between the two.

There is a significant difference in the residual lesions and in the quality of life of the patients. Additionally, reaching a clear state has been shown to be associated with longer disease remission than those who stop treatment at the near-clear stage. Some patients who become clear never relapse. Overall, it behooves us to push ourselves and our patients to achieve clear.


For more information:

Hilary Baldwin, MD, can be reached at [email protected]