Q&A: Treating rosacea without proper skin care ‘impossible’

Key takeaways:

• Julie Harper, MD, discusses the importance of utilizing proper skincare products, avoiding poor skin care products for rosacea.
• Harper also discusses what’s new in the world of rosacea treatment.

This year, Rosacea Awareness Month focuses on the importance of over-the-counter skincare products for patients with rosacea, according to the National Rosacea Society.

While patients suffering from rosacea may benefit from prescription medications, proper skin care is crucial for achieving the best outcomes. This includes not only using the right products, but also avoiding the wrong products.

Healio spoke with Julie Harper, MD, president and owner of Dermatology and Skin Care Center of Birmingham, clinical associate professor at University of Alabama-Birmingham and a member of the National Rosacea Society medical advisory board, about proper skin care, new treatments and recent developments for rosacea.

Healio: What is the importance of proper skin care vs. poor skin care for those with rosacea?

Harper: It is impossible to effectively treat and manage rosacea without proper skin care. The very best prescription medications will not be able to adequately control and clear rosacea if skincare practices are harming the skin barrier and leaving the skin red, irritated and more susceptible to triggers. Gentle skin cleansers and moisturizers are essential as is daily sun protection.

Eliminating harsh, abrasive or drying products is mandatory. Harsh and abrasive skincare products are not only hindering improvement of rosacea but they are actually actively promoting it.

Healio: What are the best treatment options for rosacea?

Harper: Proper skin care is foundational for everyone with rosacea. Otherwise, treatment varies depending on the presentation of rosacea. People with mostly rosacea bumps can benefit from topical medications such as micro-encapsulated benzoyl peroxide, ivermectin, azelaic acid, metronidazole or minocycline.

Oral antibiotics, such as doxycycline, can also be useful but long-term treatment with full doses of antibiotics should be avoided. For individuals who complain of facial redness more than bumps, topical alpha agonists, such as Rhofade (oxymetazoline, Mayne Pharma) or Mirvaso (brimonidine, Galderma) can be helpful.

There are laser and light devices that can be helpful as well.

For people with eye symptoms, or ocular rosacea, artificial tears, gentle lid massage and topical or oral antibiotics are recommended. Frequently there is an overlap of these different features of rosacea. Patients with bumps and redness and ocular symptoms will benefit most by using a combination of treatments.

Healio What new developments in rosacea research have emerged since last year?

Harper: Micro-encapsulated benzoyl peroxide has been a welcome addition to our treatment options for rosacea, the bumps of rosacea in particular. It is quite distinct from over-the-counter benzoyl peroxide, which can be irritating and can worsen rosacea. The micro-encapsulation is a novel process to wrap the drug up and then to slowly unwrap it onto the skin over time. This prevents a sudden dumping of the active ingredient onto the skin and greatly improves tolerability.

A modified release oral minocycline is also pending FDA approval. If approved, this will mark only the second oral medication specifically FDA-approved for rosacea. The other is modified release doxycycline.

Healio: What are some lifestyle changes dermatologists can recommend their patients make to improve their rosacea?

Harpe: There are many different “triggers” for rosacea and they are different for different people. I would love it if our rosacea medications could render rosacea “triggerless.” Unfortunately, it usually doesn't work that way. Triggers are not only triggering what you see on the skin, but they are triggering pathways of inflammation under the skin. It is a great idea for those with rosacea to keep a journal to identify their triggers. Some of them will be impossible to avoid, such as hot weather in Alabama. But some can be avoided, such as unprotected sun exposure.

Sun exposure has been listed as the No. 1 trigger for rosacea patients, according to a National Rosacea Society survey. Daily facial sunscreen that is broad spectrum and has at least an SPF 30 is a great idea. Mineral-based sunscreens or sunscreens for babies or sensitive skin may be particularly well-suited for those with rosacea.