Journal of Clinical and Aesthetic Dermatology

FEB 2018

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

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47 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY February 2018 • Volume 11 • Number 2 O R I G I N A L R E S E A R C H R Rosacea is a chronic disorder characterized by persistent centrofacial erythema that affects approximately 16 million adults in the United States (US). 1–3 There are several subtypes of rosacea, the most common of which is erythematotelangiectatic rosacea (ETR). 1 ETR is typified by persistent centrofacial erythema and flushing with the presence or absence of telangiectases. 4 The second most common subtype of rosacea is papulopustular rosacea (PPR), which consists of persistent centrofacial erythema along with transient, central facial papules and/or pustules. 1,4 The pathophysiology of rosacea is not completely understood. However, data suggest the involvement of an abnormally functioning innate immune detection and response system, which induces activation of inflammatory cascades. 1,4 Vasodilation, an outcome of neurovascular dysregulation, has also been implicated in the pathogenesis of rosacea. 5 In addition to the symptomatic effects of rosacea, the condition can have a substantial psychosocial impact and substantial effects on quality of life (QoL). To that end, rosacea might have a considerable impact on the lives of patients, including negative effects on self-esteem and self-confidence along with decreased QoL. 6–11 The objective of this cross-sectional survey was to assess the burden of illness associated with rosacea. A previous report from this study included analyses of sociodemographics, symptoms, treatment utilization, and satisfaction with treatment. 12 These analyses demonstrated an overall lack of satisfaction with the treatments available for rosacea, coupled with a low level of treatment utilization. These results indicated that while treatment might be effective in the short term, participants do not continue with use of specific treatments, resulting in intermittent use and low treatment satisfaction. Here, we describe the impact of rosacea symptoms on self-perception, emotional, social, and overall well-being, and rosacea-specific QoL in individuals with ETR and PPR subtypes. A B S T R A C T OBJECTIVE: The objective of the study was to evaluate the impact of rosacea on self-perception, emotional, social, and overall well-being and quality of life in individuals with erythematotelangiectatic rosacea (ETR) and papulopustular rosacea (PPR). DESIGN: We distributed a cross-sectional email invitation for participants in the United States to fill out a web-based survey. PARTICIPANTS: We included adults who reported having previously received a diagnosis of erythematotelangiectatic rosacea or papulopustular rosacea. MEASUREMENTS: Questionnaires measured the psychosocial aspects of rosacea, including the Satisfaction With Appearance Scale and modified Satisfaction With Appearance Scale questionnaires, Impact Assessment for Rosacea Facial Redness, Rosacea-Specific Quality-of-Life questionnaire, and RAND 36-Item Short Form Health Survey. The Impact Assessment for Rosacea Facial Bumps or Pimples was administered to the papulopustular rosacea cohort. RESULTS: Six hundred participants enrolled and completed the survey, with most rating their rosacea as mild or moderate (ETR: 95.6%; PPR: 93.7%). In the erythematotelangiectatic rosacea and papulopustular rosacea cohorts, respectively, 45 and 53 percent disagreed/ strongly disagreed that they were satisfied with their appearance due to rosacea; 42 and 27 percent agreed/ strongly agreed that they "worry how people will react when they see my rosacea"; and 43 and 59 percent agreed/ strongly agreed that they feel their rosacea is unattractive to others. Rosacea-Specific Quality-of-Life total and domain scores indicated negative impact of rosacea for both cohorts. Both cohorts reported worse 36-item Short Form Health Survey overall and domain scores than population norms in the United States. CONCLUSION: Rosacea had wide-ranging, negative effects on self- perceptions and emotional, social, and overall well-being as well as rosacea-specific quality of life. Overall, both erythematotelangiectatic rosacea and papulopustular rosacea cohorts reported a substantial negative impact of rosacea on quality of life on a range of instruments. KEYWORDS: Rosacea; erythematotelangiectatic rosacea; papulopustular rosacea; quality of life; psychosocial impact Quality of Life in Individuals with Erythematotelangiectatic and Papulopustular Rosacea: Findings From a Web-based Survey by JOSHUA A. ZEICHNER, MD; LAWRENCE F. EICHENFIELD, MD; STEVEN R. FELDMAN, MD, PhD; J. SCOTT KASTELER, MD; and ILIA L. FERRUSI, PhD Dr. Zeichner is with Mount Sinai Hospital in New York, New York. Dr. Eichenfield is with the University of California and Rady Children's Hospital, both in San Diego, California. Dr. Feldman is with the Wake Forest University School of Medicine in Winston-Salem, North Carolina. Dr. Kasteler is with the University of Louisville in Louisville, Kentucky. Dr. Ferrusi is with Allergan plc in Irvine, California. J Clin Aesthet Dermatol. 2018;11(2):47–52 FUNDING: This study was sponsored by Allergan plc (Dublin, Ireland). DISCLOSURES: Dr. Zeichner has been an advisory board member, consultant, or speaker for Allergan, Bayer, Foamix, Galderma, Intraderm, Isdin, Janssen, Johnson and Johnson, L'Oreal, Novan, and Promius. Dr. Eichenfield has been a consultant and investigator for Allergan, Galderma, Novan, and Valeant. Dr. Feldman has been an investigator, speaker, and/or consultant for Abbvie, Advance Medical, Caremark, Celgene, Galderma, Janssen, Kikaku, Leo Pharma, Lilly, Merck, Mylan, Novartis, Pfizer, Qurient, Sanofi, Sienna, Sun Pharmaceuticals, Suncare Research, Taro, Valeant, and Xenoport. Dr. Feldman also owns stock in Causa Technologies and Medical Quality Enhancement Corporation, has received royalties from Informa, UpToDate, and Xlibris, and is Founder and Chief Technology Officer of Causa Technologies. Dr. Kasteler has been an investigator and a speaker for Allergan, Amgen, Bayer, Novartis, and Sun Pharmaceuticals, and has participated in advisory board meetings for Amgen, Bayer, and Sun Pharmaceuticals. Dr. Ferrusi was an employee of Allergan plc at the time the study was conducted. CORRESPONDENCE: Joshua A. Zeichner, MD; Email:

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