Reach Undiagnosed Patients During Rosacea Awareness Month

Research describes a number of triggers for rosacea: UV radiation, nutrition and alcohol consumption, temperatures, and hormones, among others.^1-3 In a time when physicians and patients are facing uncertainty and restrictions due to coronavirus disease, one particular trigger that may cause an uptick in the presentation of rosacea is stress. In a survey of 1066 rosacea patients conducted by the National Rosacea Society (NRS), 79% of respondents reported a flare of their rosacea following emotional stress.⁴ Further, Haber and El Gemayel⁵ noted a statistically significant association between rosacea and depression as well as anxiety disorder. The primary features erythema, papules and pustules, and telangiectasia are generally localized to the face, making it a difficult condition to conceal when a flare develops. Given its presentation, the psychosomatic nature of rosacea^6,7 can increase the stigmatization of patients, thereby decreasing quality of life.

However, many patients may not even realize that the sustained flush they experience in times of stress and anxiety is actually a clinical sign of rosacea. To educate the public on this chronic condition, the NRS designated April as Rosacea Awareness Month.⁸ Dermatologists can take part in the month-long campaign with the free Rosacea Awareness Month Toolkit, featuring an informational flyer, the Rosacea Awareness Month rose logo, four posters on common rosacea myths for sharing on social media, and a copy of the official Rosacea Awareness Month release.⁹

Patient awareness and education is key to improving rosacea outcomes. In the early stages of disease, rosacea comes and goes as fixed centrofacial erythema in a characteristic pattern that may or may not be accompanied by secondary phenotypes.¹⁰ Without intervention, it can progress to a ruddier, more persistent state with the presentation of additional phenotypes, including ocular manifestations and rhinophyma. In another patient survey, the NRS found that 76% of 1044 respondents reported at least some improvement in their skin after receiving treatment for their diagnosed rosacea.⁸ Among those, 40% reported improved psychological well-being, 35% reported better social well-being, and 31% reported improvements in occupational well-being. The positive effects of treatment are even greater when almost clear or clear skin is achieved; 81%, 71%, and 62% reported improved psychological, social, and occupational well-being, respectively.

Rosacea Awareness Month follows closely after the release of updated management options as determined by the expert committee of the NRS.¹¹ In the literature review, Thiboutot et al¹¹ examined the safety and efficacy of the various therapies for rosacea treatment. They reported efficacy in the treatment of rosacea with:

• Light therapy: pulsed dye lasers, intense pulse light, potassium titanyl phosphate;
• Oral therapy: azithromycin, doxycycline, minocycline, isotretinoin, and trimethoprim/sulfamethoxazole; and 
• Topical therapy: brimonidine topical gel 0.33%, oxymetazoline hydrochloride cream 1%, azelaic acid 15%, ivermectin cream 1%, metronidazole 1% and 0.75%, and sodium sulfacetamide 10%.

In addition to therapies, the committee recommended lifestyle management and skin care. Patients are advised to record in a daily exposure diary to help identify potential rosacea triggers. Gentle skin care, including the daily use of sunscreen, gentle cleansers, and nonocclusive moisturizers, is highlighted as well.

The Rosacea Awareness Month Toolkit from the NRS is available for free download at rosacea.org/ram. Physicians can also request more information and materials such as patient handouts and a clinical scorecard for their practice by calling the NRS at 847-382-8971 or emailing info@rosacea.org.

References
1. Rainer BM, Kang S, Chien AL. Rosacea: epidemiology, pathogenesis, and treatment. Dermatoendocrinol. 2017;9(1):e1361574. doi:10.1080/1938.2017.1361574

2. Alinia H, Tuchayi SM, Patel NU, et al. Rosacea triggers: alcohol and smoking. Dermatol Clin. 2018;36(2):123-126. doi:10.1016/j.det.2017.11.007

3. Factors that may trigger rosacea flare-ups. National Rosacea Society. Accessed March 27, 2020. https://www.rosacea.org/patients/rosacea-triggers/factors-that-may-trigger-rosacea-flare-ups

4. Rosacea triggers survey. National Rosacea Society. Accessed March 27, 2020. https://www.rosacea.org/patients/rosacea-triggers/rosacea-triggers-survey

5. Haber R, El Gemayel M. Comorbidities in rosacea: a systematic review and update. J Am Acad Dermatol. 2018;78(4):786-792.e8. doi:10.1016/j.jaad.2017.09.016

6. Šitum M, Kolić M, Buljan M. Psychodermatology [in Croatian]. Acta Med Croatica. 2016;70(suppl 1):35-38. 

7. Böhm D, Schwanitz P, Stock Gissendanner S, Schmid-Ott G, Schulz W. Symptom severity and psychological sequelae in rosacea: results of a survey. Psychol Health Med. 2014;19(5):586-591. doi:10.1080/13548506.2013.841968

8. Erhard M, Huff A. Rosacea awareness month to focus on new management options. News release. National Rosacea Society. February 19, 2020. Accessed March 27, 2020. https://www.rosacea.org/press/2020/february/rosacea-awareness-month-to-focus-on-new-management-options

9. Rosacea awareness month. National Rosacea Society. Accessed March 27, 2020. https://www.rosacea.org/patients/rosacea-awareness-month

10. Gallo RL, Granstein RD, Kang S, et al. Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. 2018;78(1):148-155. doi:10.1016/j.jaad.2017.08.037

11. Thiboutot D, Anderson R, Cook-Bolden F, et al. Standard management options for rosacea: the 2019 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. Published online February 6, 2020. doi:10.1016/j.jaad.2020.01.077