Download WhitePaper Rosacea June2014

ROSACEA
Dr. Charlene DeHaven M.D.
Papules and pustules may be visible in rosacea as in
Clinical Director, INNOVATIVE SKINCARE ®
acne. However, sebaceous plugging is not causative in
rosacea as it is in acne. There may be bacterial
PREVALENCE
overgrowth as the disease becomes more severe, but
Rosacea is a common but greatly misunderstood
the presence of bacteria is also not causative as
disorder of the facial skin that is estimated to affect
in acne.
upwards of 14 million adult Americans, with
approximately only 25% of the population even aware
The first stage of rosacea is merely vascular
of it. This serious disorder is known to affect more
hyperreactivity. This can occur in the 20s or 30s and is
women than men; however, men are far more likely to
usually not identified as rosacea. In fact, rosacea
seek treatment. Specifically, more men develop the
progresses so gradually that it may go completely
advanced sequelae of severe telangiectasias (dilated
undetected and undiagnosed, even after the facial
blood vessels, or spider veins) and rhinophyma (red,
changes are obvious. The early stage is very difficult to
bulbous nose).
treat, except, for particular individuals, by avoiding
some triggers (listed on page 2).
As rosacea typically begins between the ages of 30 and
50, the first stages may be barely detectable by the
During the course of rosacea, at least 50% of patients
patient and not at all by others. The most common
have some type of ocular (eye-related) symptom.
age for onset is in the 40s and 50s. The vascular
Ocular symptoms can be found in the first stage and
reactivity seen in rosacea is most common in
may be the only symptoms the patient notices;
fair-skinned individuals of Irish and Scandinavian
however, ocular symptoms are frequently found as the
descent and is seen in persons who already have
disease progresses. Ocular complaints may include dry
vascular hyperreactivity, or tendency for the central
eye, stye development, contact lens intolerance,
face to redden easily (e.g., those who blush easily).
redness of the eyelids, or even corneal damage with
ulcerations. When the patient complains only of eye
ETIOLOGY (CAUSE) AND PROGRESSION OF DISEASE
symptoms, the term ocular rosacea is sometimes used.
Rosacea is a chronic and progressive disease with many
flare-ups and remissions. The etiology of rosacea lies
After an initial stage of intermittent facial flushing, the
with hyperresponsiveness of the blood vessels of the
disease most often progresses to constant erythema
central face. Exactly why some people develop rosacea
(redness) of the cheeks, forehead, chin, and nose;
and others do not is uncertain. A number of factors
stinging or burning of the face; increased pore size;
may play a role, including genetic background,
and ocular symptoms. Then papules and pustules
composition of skin microflora, individual inflammatory
develop, telangiectasias appear, and nasal bumps that
mediators, individual triggers, and others. Alcohol was
increase in number and size until, finally, rhinophyma
once thought to be causative, but it has never been
occurs. Rhinophyma is certainly disfiguring, and even
proven to be linked directly to the development of the
the papular/pustular stage is very unattractive. The
disease. However, alcohol does cause vasodilatation
skin and subcutaneous (just below the skin) tissue of
and can serve as a disease trigger.
the nose are affected by rhinophyma, but the
supporting structures of cartilage and bone remain
intact and are not affected. The lack of involvement of
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the supporting framework of the nose makes
been known for some time, persons with rosacea used
rhinophyma more amenable to surgical treatment than
to be assumed to be alcoholics. The occurrence of
it would be if these structures were affected.
rosacea does not mean the individual is an alcoholic.
Rosacea can be considered an age-related disease.
DISEASE TRIGGERS
Even though the very first symptoms of disease can
The following substances are known to trigger rosacea,
appear in the 20s, 30s, or 40s, most people are not
although this occurs with varying frequency. The most
actually diagnosed with rosacea until their 40s or 50s
well-known trigger is alcohol. It should be emphasized
because of its slow, gradual progression.
again that the occurrence of rosacea should not label a
person an alcoholic. The occurrence of rosacea,
The progression of this disorder also means that
however, will cause the physician to recommend
patients’ quality of life can be affected. Degrees of
avoidance of alcohol since this is such a
psychological distress range from mild to severe.
common trigger.
Individuals affected may quantify the severity of their
symptoms according to the RosaQol, a 21-question
Foods also can be common triggers. Potential food
quality-of-life rating scale describing the individual’s
triggers include hot peppers, Mexican food, Thai food,
symptom severity. The RosaQol is a standardized
red pepper, hot sausage, black pepper, vinegar,
assessment tool which is well-described in the medical
paprika, white pepper, and garlic. These foods are
literature and commonly used by doctors who treat
listed in descending order of reported frequency for
rosacea patients.
triggering rosacea. Very hot beverages may be a
trigger in some patients. Note that these foods also
Assessment of the severity of rosacea can be performed
are known for causing vasodilatation, which would
by the clinician according to the following parameters:
lead to flushing.
(1) investigator global assessment of rosacea severity
(IGA score), (2) erythema, (3) papule/pustule count,
Other potential triggers are environmental, such as sun
and (4) telangiectasias.
exposure and cold weather. Stress also may trigger an
exacerbation of symptoms.
MISDIAGNOSIS OF ROSACEA
Rosacea is commonly misdiagnosed. Rosacea is not
TREATMENT
acne, although this is its most common mislabeling.
Rosacea may prove frustrating to treat, for both patient
The cause of rosacea is different from that of acne.
and clinician, although several topical and systemic
Some of the drugs used to treat rosacea are also used
pharmaceuticals are available. The first line of
to treat acne, and this may add to the confusion.
treatment is to avoid any triggering or exacerbating
factors. Topical antibiotics such as metronidazole,
Tumors, such as lymphoma, basal cell carcinoma of the
azelaic acid, or other agents may be long-term options.
nose or face, or squamous cell carcinoma of the nose
Topical retinoid therapy may be used along with
or face, also may be confused with rosacea in its later
systemic treatment with oral antibiotics. In severe
stages. This can have disastrous consequences for the
cases, surgery (including laser therapy and other
patient, leaving a potentially treatable condition to
techniques) may be used for unsightly telangiectasias
progress to a more serious stage that is much more
or rhinophyma.
difficult to treat or may even be untreatable.
Over-the-counter preparations are often tried by
Sarcoid presenting in the nose can appear to be
persons with rosacea, either as a first try at treatment
rosacea. Because alcohol as a triggering factor has
or because of frustration with prescribed medications.
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© 2014 Science of Skincare, LLC. All rights reserved.
The formulation method and choice of ingredients,
including vehicles (dissolving agents), is very
vanZuuren EJ et al, “Interventions for Rosacea,” Cochrane Database
Syst Rev. 2011 Mar16;(3):CD003262.
Lazaridou E et al, “The Potential Role of Microorganisms in the
Development of Rosacea,” J DtschDermatolGes (English).
2011Jan;9(1):21-5.
important in the efficacy and success of
over-the-counter products.
PRODUCT RECOMMENDATIONS
iS CLINICAL ® products recommended for rosacea include
CREAM CLEANSER, CLEANSING COMPLEX,
HYDRA-COOL ® SERUM, YOUTH EYE ™ COMPLEX,
Del Rosso JQ, “Effectiveness and Safety of Doxycycline 40 mg (30
mg Immediate-Release and 10 mg Delayed-Release Beads)
Once Daily as Add-On Therapy to Existing Topical Regimens
for the Treatment of Papulopustular Rosacea: Results from a
Community-Based Trial,” Cutis. 2010Nov;86(5Suppl):16-25.
Webster GF, “An Open-Label, Community-Based, 12-Week
Assessment of the Effectiveness and Safety of Monotherapy
with Doxycycline 40 mg (30 mg Immediate-Release and 10 mg
Delayed-Release Beads),” Cutis. 2010Nov;86(5Suppl):7-15.
BODY COMPLEX, EYE COMPLEX,
MOISTURIZING COMPLEX, and PRO-HEAL ® SERUM
ADVANCE + ®.
Scheinfeld N et al, “A Review of the Diagnosis and Treatment of
Rosacea,” Postgrad Med. 2010 Jan;122(1):139-43.
Recommended iS products for rosacea include
PROTECTIVE MOISTURIZER SPF 15, EXTREME PROTECT
SPF 30, COOLMINT REVITALIZING MASQUE,
REPARATIVE MOISTURIZER,
RESTORATIVE EYE COMPLEX, and ECLIPSE SPF 50+.
Recommended INNOVATIVE SKINCARE ® Professional
Products for rosacea include REJUVENATING MASQUE.
Odom R et al, “Standard Management Options for Rosacea, Part II:
Options According to Subtype,” Cutis.
2009Aug;84(2):97-104.
Odom R et al, “Standard Management Options for Rosacea, Part I:
Overview and Broad Spectrum of Care,” Cutis.
2009Jul;84(1):43-7.
Thiboutot DM et al, “A Multicenter Study of Topical Azelaic Acid
15% Gel in Combination with Oral Doxycycline as Initial
Therapy and Azelaic Acid 15% Gel as Maintenance
Monotherapy,” J Drugs Dermatol. 2009Jul;8(7):639-4.
Nicholson K et al, “A Pilot Quality-of-Life Instrument for Rosacea,”
J Am AcadDermatol. 2007Aug;57(2):213-21.
REFERENCES
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Nakatsuji T et al, “Antimicrobial Peptides: Old Molecules with New
Ideas,” J Invest Dermatol. 2011 Dec8;(Epub).
vanZuuren EJ et al, “Effective and Evidence-Based Management
Strategies for Rosacea: Summary of a Cochrane Systematic
Review,” Br J Dermatol. 2011Oct;165(4):760-81.
Wolf JE Jr et al, “The CLEAR Trial: Results of a Large
Community-Based Study of Metronidazole Gel in Rosacea,”
Cutis. 2007Jan(1):73-80.
vanZuuren EJ et al, “Systematic Review of Rosacea Treatments,” J
Am AcadDermatol. 2007 Jan;56(1):107-15.
Fleischer A et al, “The Face and Mind Evaluation Study: an
Examination of the Efficacy of Rosacea Treatment Using
Physician Ratings and Patients’ Self-Reported Quality-of-Life,”
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Levin J et al, “A Guide to the Ingredients and Potential Benefits of
Over-the-Counter Cleansers and Moisturizers for Rosacea
Patients,” J ClinAesthetDermatol. 2011Aug;4(8):31-49.
Gupta AK et al, “Critical Review of the Manner in Which Efficacy of
Therapies for Rosacea Are Evaluated,”Int J Dermatol.
2003Nov;42(11):909-16.
Fleischer AB Jr, “Inflammation in Rosacea and Acne: Implications for
Patient Care,” J Drugs Dermatol. 2011 Jun;10(6):614-20.
Gessert CE et al, “Measuring the Severity of Rosacea: a Review,”Int
J Dermatol. 2003Jun;42(6):444-8.
Jackson JM et al, “Topical Rosacea Therapy: The Importance of
Vehicles for Efficacy, Tolerability, and Compliance,” J Drugs
Dermatol. 2011 Jun;10(6):627-33.
DeNoon, “Rosacea,” WebMD Health, Aug 21, 2003.
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All materials contained on this document are protected by United States copyright law. You may not modify, remove, delete, publish, transmit, reproduce or in any way exploit the content of this document, in whole or in part.
© 2014 Science of Skincare, LLC. All rights reserved.
Berkley C, “More Foods Act as Rosacea Triggers,” WebMD Health;
Jul 25, 2003.
Rohrich RJ, Griffin JR, Adams WP, “Rhinophyma: Review and
Update,”PlastReconstrSurg, 2002Sep 1;110(3):860-69.
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Overlooked, Condition”; Am FamPhysician, 2002 Aug
1;66(3):442
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Mar;136(3):393-9.
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Sep;82(5):1145-5.
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All materials contained on this document are protected by United States copyright law. You may not modify, remove, delete, publish, transmit, reproduce or in any way exploit the content of this document, in whole or in part.
© 2014 Science of Skincare, LLC. All rights reserved.