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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Page 26 of 63

27 JCAD journal of clinical and aesthetic dermatology June 2017 • Volume 10 • Number 6 management, changing exercise regimens, and avoiding sun exposure, hot baths/saunas, and certain skin products. Treatment utilization findings suggest limited use of topical and oral prescription agents, especially for long-term management to reduce exacerbations. Rather, most respondents reported reliance on sun protection. The most commonly used prescription agent was topical metronidazole, which was used by 33 percent of participants. Overall, the use of prescription agents was low, with most participants reporting no use within the previous month of metronidazole, azelaic acid, brimonidine, ivermectin, doxycycline, or other oral agents, or of prescription topical cleansers. The limited and perhaps inconsistent use of these prescription agents may be attributable to the perceptions of many patients of poor long-term efficacy in the real-world management of rosacea, since only about half of the participants who reported using them were satisfied or very satisfied with these treatments. By contrast, participants indicated a high rate of sun protection usage, which is in line with rosacea management guidelines and recommendations. 1,2 The most common usage of prescription treatments among the study participants was to treat a rosacea flare up. It is difficult to discern from these data whether the patients actually used their prescription medication for a sufficient period of time to result in the expected outcome. The chronic nature of rosacea often necessitates the use of a continued therapeutic regimen once remission is achieved in order to sustain effective control of the disorder. 20,34-36 The low levels of treatment satisfaction reported in this study contrast with much higher treatment satisfaction results, such as those reported immediately following four weeks of treatment with doxycycline. 37 Taken together, these results suggest that prescription treatments are effective, but are not consistently used. Consequently, there is a need for patient education about the chronic nature of rosacea and the necessity for continued maintenance treatment to achieve optimal outcomes. This may help to set reasonable expectations for treatment success. 20,31 Implementation of such a patient education program may result in increased utilization Figure 4A. Scenarios in which participants used topical prescription agents for the management of rosacea. ETR=erythematotelangiectatic rosacea; PPR=papulopustular rosacea O R I G I N A L R E S E A R C h

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