Rosacea Diagnosis and Management

Diagnostic Features

Rosacea is characterized by persistent centrofacial erythema associated with periodic intensification, and phymatous changes, according to the British Journal of Dermatology 3, 4
The disease often presents with flushing, telangiectasia, inflammatory lesions, and ocular manifestations, as reported by the British Journal of Dermatology 2, 3
Secondary features may include burning or stinging sensations, erythematous plaques, facial dryness and scaling, and edema, as noted by the British Journal of Dermatology 1, 2

Approximately 16 million people in the United States are affected by rosacea, according to Drugs 5, 6
Many cases remain undiagnosed, particularly in people with skin of color, as reported by Drugs 5, 6

The exact pathophysiology of rosacea remains incompletely understood, but it involves dysregulation of both innate and adaptive immune systems, according to the British Journal of Dermatology 2, 7
Key pathophysiological mechanisms include increased levels of antimicrobial peptides, neuropeptides, and nitric oxide radical species, as reported by the British Journal of Dermatology 2, 3
Trigger factors such as Demodex mites and ultraviolet radiation exposure may activate inflammatory pathways, according to the British Journal of Dermatology 2, 3

The current approach to rosacea classification has shifted from subtype-based to phenotype-based, as reported by the British Journal of Dermatology 8, 7
Traditional subtypes included erythematotelangiectatic rosacea, papulopustular rosacea, phymatous rosacea, and ocular rosacea, according to the British Journal of Dermatology 1, 2

Treatment is now guided by phenotype rather than subtype, and targets the specific signs and symptoms observed by the clinician and those most bothersome to the patient, as reported by Drugs 5, 6
General management principles include long-term avoidance of triggers, gentle skincare, and adherence to pharmacologic treatment, according to Drugs 5, 6
Multiple features in an individual patient can be simultaneously treated with multiple agents, as noted by the British Journal of Dermatology 9, 8

Ocular manifestations include blepharitis, blurred vision, foreign body sensation, hyperemia, photophobia, redness, tearing, and telangiectasia, according to the British Journal of Dermatology 9
Management includes lid hygiene, artificial tears for mild burning/stinging, and ophthalmological referral for all but the mildest ocular features, as reported by the British Journal of Dermatology 8, 10

Maintenance therapy depends on treatment modality and patient preferences, and the minimum treatment necessary to maintain control should be used, according to the British Journal of Dermatology 9, 8
Treatments should be given sufficient time before switching to alternatives, as noted by the British Journal of Dermatology 9, 8
Moderate and severe presentations of major features typically require combination therapy, according to the British Journal of Dermatology 9

Encapsulated benzoyl peroxide 5% (E-BPO 5%) is a newly FDA-approved topical treatment for rosacea, as reported by Drugs 5, 6
E-BPO 5% uses microencapsulation technology to improve therapeutic effects while minimizing skin irritation, according to Drugs 5, 6