Journal of Clinical and Aesthetic Dermatology

JUN 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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18 JCAD journal of clinical and aesthetic dermatology June 2017 • Volume 10 • Number 6 O R I G I N A L R E S E A R C h pathophysiologic components: 1) abnormality in innate immune detection and 2) neurovascular dysregulation. Triggering of these pathophysiologic mechanisms in rosacea-prone skin induces signaling in inflammatory cascades in response to certain stimuli that lead to specific clinical manifestations of rosacea. 2 ,5-15 Vasodilation of facial vasculature, both acute and chronic, has been documented in rosacea, along with impairment of the stratum corneum permeability barrier. 4–6,8,9,11,16–19 Various treatments for the management of PPR are approved in the United States, including topical metronidazole, topical azelaic acid, topical ivermectin, and oral doxycycline (modified 40mg once- daily formulation), which are all reported to have anti-inflammatory properties. 20,21 Given the central role of persistent erythema across rosacea subtypes, developing treatments that are specifically aimed at reducing erythema is an important goal for effective management of the symptoms and psychosocial impact of rosacea. 7 Two topical pharmacologic agents currently approved in the United States for the treatment of persistent non-transient erythema of rosacea include brimonidine gel, an alpha-2 adrenergic receptor agonist vasoconstrictor, 22-24 and oxymetazoline cream, an alpha-1 adrenergic receptor agonist. 11,25–27 In addition to the characteristic physical discomfort associated with rosacea, such as burning, itching, and stinging, 28 the condition may also have a considerable adverse psychosocial impact on quality of life. 29 Negative effects on self-esteem and self- confidence have been documented. 29,30 While available treatments are primarily targeted at managing the clinical signs and symptoms of rosacea, effective treatment can also reduce the psychosocial impact of rosacea. 31 However, although these treatments are effective, rosacea is a chronic disease that often requires ongoing management. Some patients may temporarily discontinue medication use because their signs and symptoms vary in severity over time, because they consider continuous treatment too costly or inconvenient, or because they consider potential or experienced side effects of treatments too burdensome, resulting in only intermittent therapy to treat flare-ups. 32 To further investigate the burden that rosacea imposes on patients with the condition, a survey was conducted in the United States in adults with ETR and with PPR to evaluate the perception of rosacea signs and symptoms and available treatments. This analysis reports on the impact of rosacea on patients' lives as well as their satisfaction with treatment. METHODS This cross-sectional, web-based survey of adults with rosacea was conducted from May 8 to July 1, 2015. Respondents were screened for inclusion, and eligible respondents were invited to participate in a one- time web-based survey. The Chesapeake Institutional Review Board (Columbia, Maryland) approved the study protocol, and the study was conducted in accordance with regulatory guidelines and with requirements for studies involving human respondents. Study participants provided informed consent via a web- [Abstract continued] P articipants reported avoiding sun exposure, hot baths and saunas, and specific skin care products to circumvent potential rosacea Nare-ups. More than half (55.7%) had used a prescribed topical agent for rosacea in the preceding month, and 26.3 percent had used a prescribed oral antibiotic. Fewer than half were satisMed with treatment outcomes. Conclusion: Despite the chronic nature of rosacea, participants commonly used prescription agents only to treat Nare-ups and relied on sun protection and other avoidance mechanisms to reduce their frequency. Education is needed to communicate the long-term nature of rosacea and the need for continued treatment to maintain long-term control. J Clin Aesthet Dermatol. 2017;10(6):17–31.

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