Examine all rosacea phenotypes when devising a treatment plan

The National Rosacea Society recently recommended dermatologists update their rosacea treatment plans to better take into consideration all aspects of the disease and how they each affect the patient.

Based on a roundtable of leading dermatologists, the recommendations specifically discuss erythema and how to address redness as the disorder’s standard classification and management systems are updated.

“This paper is reiterating the importance of a phenotypic description of rosacea moving forward,” Hilary Baldwin, MD, associate professor of dermatology at Rutgers Robert Wood Johnson Medical School and one of the authors of the paper, told Healio. “Many of the consensus groups and expert groups have been calling for the disillusion of the older way of categorizing rosacea.”

Rosacea should be considered a single disease with multiple potential phenotypes including facial erythema, phymatous changes, papules and pustules, flushing, telangiectasia and ocular manifestations, the paper recommends.

Any two of these phenotypes can be considered diagnostic, with stinging, edema and dryness being secondary phenotypes.

Using this new system allows clinicians to focus on the parts of the disease that most affect the patient.

“Every time a patient sits down in front of you, it’s important to categorize every aspect of their rosacea,” Baldwin said. “I like to sit with the patient with a mirror and point out all of those changes to them individually and ask them which of these aspects bothers them the most and then devise a treatment program based on that.”

In a survey of 1,675 rosacea patients, 82% reported erythema had a negative impact on their life.

Targeting each phenotype with a multi-therapy approach can lead to the best patient satisfaction outcomes, the roundtable participants agreed.

“You pair the signs and symptoms of the disease with the desires of the patients,” Baldwin said.