In her presentation at the inaugural Symposium for Inflammatory Skin Disease, Hilary Baldwin, MD, FAAD, guided attendees through the updates in rosacea diagnosis and management.
Dermatology recently had a consensus transition from subtypes to phenotypes based on the two diagnostic features of rosacea and its major and minor phenotypes, said Dr Baldwin. With these new diagnostic criteria, is there an opportunity to incorporate a new descriptive terminology? She explained “STOPP,” a tool graded on a 5-point scale (1 = none, 5 = severe):
- S: symptoms
- T: telangiectasias and erythema
- O: ocular involvement
- P: papules and pustules
- P: phyma
In addition to the new diagnostic criteria, rosacea has some novel treatments in its therapeutic toolbox. However, because rosacea has many presentations, it is important for patients and providers to understand that multiple modalities may need to be used. “Ask the patient which symptom is more bothersome and go after that first,” suggested Dr Baldwin. In addition, consider the severity of the rosacea symptoms and patient preference, as these factors can affect the choice between topical alone vs topical plus oral plus oral alone.
For telangiectasias and flushing, intense pulsed light (IPL) and vascular lasers are the best options for treatment. The literature also reports success with alpha agonists and beta blockers. Background erythema, which may also benefit from IPL and vascular lasers, also has the FDA approved treatments brimonidine and oxymetazoline; the literature notes use of azelaic acid and supramolecular salicylic acid (SSA). Papules and pustules have a number of approved drugs: ivermectin, metronidazole, azelaic acid, SSA, and subantimicrobial dose doxycycline. Other treatments that may be effective for papulopustular symptoms may be tacrolimus, dapsone gel, isotretinoin, and antibiotics.
Phyma, or swelling/growth of the skin, is most effectively treated through ablative techniques, though isotretinoin may work as well. The noncutaneous consideration, ocular symptoms, may be treated with topical oxymetazoline.
Reference
Baldwin H. Rosacea. Presented at: Symposium for Inflammatory Skin Disease; April 9-11, 2021; virtual.
