Optimizing Rosacea Care

The National Rosacea Society (NRS) hosts Rosacea Awareness Month every April to “educate the public on the treatments available for this chronic facial skin disorder” known to affect more than 16 million Americans.¹ This year, the NRS is shining a light on “giving new treatments enough time to work.”¹ In this interview, Estee Williams, MD, discusses how physicians can work together with their patients to optimize care when treating rosacea.

The Dermatologist: How can physicians utilize shared decision-making to encourage treatment adherence?

Dr Williams: Patients should be followed very closely because treatments do tend to continue to improve over time. Sometimes, even if the results are not optimal at 6 to 8 weeks, that does not mean it will not continue to get better if patients follow and adhere to the regimen for a longer time. The way I do it is by observing some positive results, usually by 6 weeks, and then encouraging the patient to continue. There are long-term studies of certain treatments and combinations of treatments showing that improvement can continue for up to a year, meaning that sometimes improvement is slow. So, it is important for patients not to give up and to give the treatment time to work.

At the end of the day, it is the patient who is dealing with the condition. Because rosacea is a chronic condition with no cure, it is worthwhile to have a discussion with the patient upfront. Depending on the patient’s case, physicians can determine whether one medicine, laser, or modality at a time could have an impact by itself. This would be determined by whether the patient is in a rush. It also depends on the patient’s willingness to follow the treatment regimen. Some patients may be more comfortable taking a pill but will not use a topical, or they will use a cream but will not take pills.

Sometimes a physician may prescribe a treatment that works great for 6 weeks, and then the patient believes they can just stop the treatment. We need to remind them that this is a chronic condition, and it is for the long term. This also applies to optimizing patient adherence. We need to make sure we are having a conversation about their expectations, how aggressive their treatment can be, and their willingness to use one or more topical or oral medications. This can also include how motivated they are to incorporate lasers or intense pulsed light, which may result in a huge change in a short amount of time. For me, I think the best thing is to usually combine treatments together, but you really need to know what is on the patient's mind.

The Dermatologist: What additional strategies can physicians utilize as treatment progresses?

Dr Williams: Over time, even if patients do see a great improvement or may be clear, it is important to emphasize that we are treating not just what we see but also symptoms. We are still treating skin sensitivity, tightness, and itching. Also, we need to explain to patients that if they stop medicating, then the rosacea can come back. Being clear is not an indication that they are ready to stop their treatment. If a patient has been on therapy for some time where they have been compliant without any fl ares and they really want to stop, then I will tell them, “Let’s do a test. We could stop everything and see what happens. If it comes back right away, then we need to continue treatment.” So, every now and then when a patient may want to take a holiday, give them a warning but allow them to try it.

The Dermatologist: Is there anything else you would like to share with your colleagues?

Dr Williams: The most critical piece is to have the correct diagnosis. When physicians are not in the right category, then they are prescribing medications that are not appropriate for rosacea. They also need to remember that redness and sensitivity are not enough to diagnose rosacea. We have many other skin conditions that can look like rosacea. For example, pimples are seen in both acne and rosacea. In fact, acne and eczema are usually the conditions that are most misdiagnosed as rosacea. It is also important to have patients follow up, especially in the beginning. Their response to the treatment may give physicians a clue if rosacea is the right diagnosis. We must really question if we have the right diagnosis and following patients closely, especially in the beginning every 4 to 6 weeks, can help with that.

Reference:

1. Rosacea Awareness Month to highlight the importance of consistency and patience when trying new therapies. Press release. National Rosacea Society. February 7, 2023. Accessed March 24, 2023. https://www.rosacea.org/press/2023/february/rosacea-awareness-month-to-highlight-importance-of-consistency-patience-when-trying-new-therapies