GUIDELINES for the standard treatment options of rosacea, including recommendations for oral therapies, topical therapies, and light-based devices, have been updated by the National Rosacea Society. Reviewing the safety and efficacy of numerous therapeutic strategies, a panel of convening experts also included additional diagnostic features of the condition in a new standard classification system, including fixed centrofacial erythema and phymatous changes.
Regarding the use of light devices, the panel agreed that these are most effective for the treatment of fixed phymas, and should include cold steel, electrosurgery, radiofrequency, or CO2 and erbium. Acknowledging the well-established use of pulsed dye and potassium titanyl phosphate lasers in clinical practice, the panel also noted their effective use for erytherma treatment in some studies.
Regarding the use of oral therapies for the papule/pastule diagnostic feature, azithromycin, doxycycline, minocycline, isotretinoin, and trimethoprim/sulfamethoxazole were agreed upon. Attributing to concerns regarding fetal and maternal toxicity, oral isotretinoin, and tetracycline were advised against during pregnancy. Ocular rosacea treatment included the continual recommendation of eyelash hygiene and oral omega 3 supplementation, the former of which constituting the application of a warm compress to the eyelids and the cleaning of the eyelashes twice daily with baby shampoo.
Lifestyle management and skin care were also addressed by the panel. The keeping of daily lifestyle and environmental exposure diaries was recommended in patients for the identification of specific rosacea flare-up triggers, including wind, spicy foods, and sun exposure. Although rosacea is typically characterised by skin sensitivity and as such skin care must be gentle, sunscreen application was unanimously advocated for the prevention of flushing and erythema. As opposed to those with chemical filters, physical sunscreens containing either zinc oxide or titanium dioxide were recommended.
Concluding their meeting, the guideline committee claimed that: “The new phenotype-based standard classification and management of rosacea provide important insights and guidance for the selection of treatments and broad spectrum of care to achieve optimal patient outcomes.”