Background On The Burden of Persistent Redness

For patients with rosacea, facial redness is one of the most common and often the only visible symptom.^1,2  

Recent changes in clinical understanding and recommendations for managing rosacea have placed increased emphasis on persistent facial redness. It is one of the primary diagnostic features of rosacea and can significantly impact a patient’s quality of life.^1,3

Erythema often presents with papules and pustules (also known as perilesional erythema) and with other clinical signs and symptoms, such as burning, stinging, flushing, facial edema, telangiectasias and pruritus—all of which can come and go in patients with rosacea.^2.4 However, persistent redness distinct from other manifestations, known as transient facial erythema, can persist in the absence of other symptoms, last longer, and occur more frequently as the disease progresses.^2,3    

Survey Says: It's The Most Bothersome Rosacea Symptom

A 2019 survey conducted by rosacea experts and the National Rosacea Society found 69% of 708 eligible patients with reported persistent facial erythema to be their most bothersome symptom.¹ The survey also showed that the more severe a patient’s erythema, the more substantially the disease impacts their quality of life.¹

Since 2016, the global ROSacea Consensus (ROSCO) panel of experts has recommended that “persistent centrofacial redness associated with periodic intensification by potential trigger factors” should be considered an independent diagnostic criterion for rosacea.⁵ [ Schaller 2017, p3, Table 1, Legend, L. 3-4] Changes like this stem from new scientific understanding of rosacea’s disease pathology and have led to new clinical approaches to treatment. This results in clinicians who view rosacea as a single disease with multiple potential phenotypes and find treatment options based on individuals’ interrelated signs and symptoms. Of all the visible manifestations that can develop with rosacea, persistent facial erythema is unique in that it is the only visible sign experienced by 100% of rosacea patients across all stages and subtypes of the disease.^4.6   

Tips To Help Rosacea Patients Manage Persistent Redness

The good news is that dermatologists have prescription options for patients who are concerned about persistent facial redness; however, taking an active role in managing facial erythema  beyond prescription treatments or expensive energy-based therapies is difficult. 

The American Academy of Dermatology Association (AAD) recommends that patients with rosacea-associated erythema discuss triggers and several treatment options with their dermatologist, including the following:     

• Common causes of rosacea and trigger management: Identifying and avoiding triggers is a key part of any management plan. Discussing trigger factors and how to avoid them with patients with rosacea is widely recommended across current treatment guidelines .^3,7,8

• UV/Sun protection: A National Rosacea Society (NRS) survey reported sun exposure to be the most common trigger of rosacea flares (81% of 1066 patients).^ix Experts say that basic education on why and how the sun triggers rosacea has been shown to be effective in improving patients’ use of sun protection.¹⁰

• General skin care for rosacea: Some ingredients found in sunscreens, creams, and lotions, such as alcohol and fragrances, can worsen erythema and cause rosacea symptoms to flare. Choosing rosacea-sensitive skin care products can help cleanse, moisturize, and protect the face and reduce sun sensitivities and other triggers of rosacea.¹¹

• Green-tinted makeup: Although green-tinted makeup doesn’t treat facial redness, it does help hide it. Both the NRS and AAD recommend products made specifically for people with rosacea.^12,13

While persistent facial erythema is not the only challenge for patients with rosacea, facial redness, coupled with symptoms of burning and stinging, is often the earliest sign of the disease.^4,7 Early diagnosis and treatment may alleviate psychosocial distress, improve mental health and quality of life outcomes, and help to avoid permanent skin changes in later stages of the disease. This often starts with recognizing facial redness as an early sign of rosacea.^2,14

References:

1. Baldwin HE, Harper J, Baradaran S, Patel V. Erythema of rosacea affects health-related quality of life: results of a survey conducted in collaboration with the National Rosacea Society. Dermatol Ther (Heidelb). 2019;9(4):725-734. doi:10.1007/s13555-019-00322-5

2. Del Rosso JQ. Advances in understanding and managing rosacea: Part 2: the central role, evaluation, and medical management of diffuse and persistent facial erythema of rosacea. J Clin Aesthet Dermatol. 2012;5(3):26-36.

3. Gallo RL, Baldwin H, Gold LS, Harper J. Update on facial erythema in rosacea. J Drugs Dermatol. 2021;20(8):861-864. doi:10.36849/JDD.6062

4. Scharschmidt TC, Yost JM, Truong SV, Steinhoff M, Wang KC, Berger TG. Neurogenic rosacea: a distinct clinical subtype requiring a modified approach to treatment. Arch Dermatol. 2011;147(1):123-126. doi:10.1001/archdermatol.2010.413

5. Schaller M, Almeida LMC, Bewley A, et al. Rosacea treatment update: Recommendations from the global ROSacea COnsensus (ROSCO) panel. Br J Dermatol. 2017;176(2):465-471. doi:10.1111/bjd.15173

6. Schaller M, Dirschka T, Lonne-Rahm SB, et al. The importance of assessing burning and stinging when managing rosacea: A review. Acta Derm Venereol. 2021;101(10):adv00584. doi:10.2340/actadv.v101.356

7. Buddenkotte J, Steinhoff M. Recent advances in understanding and managing rosacea. F1000Res. 2018;7:F1000 Faculty Rev-1885. doi:10.12688/f1000research.16537.1

8. Oge' LK, Muncie HL, Phillips-Savoy AR. Rosacea: diagnosis and treatment. Am Fam Physician. 2015;92(3):187-196.

9. National Rosacea Society. Rosacea triggers survey.  Accessed October 12, 2021. https://www.rosacea.org/patients/rosacea-triggers/rosacea-triggers-survey

10. McCoy WH IV. “Shedding light” on how ultraviolet radiation triggers rosacea. J Invest Dermatol. 2020;140(3):521-523. doi:10.1016/j.jid.2019.09.008

11.  Del Rosso JQ, Thiboutot D, Gallo R, et al. Consensus recommendations from the American Acne & Rosacea Society on the management of rosacea, part 1: A status report on the disease state, general measures, and adjunctive skin care. Cutis. 2013;92(5):234-240.

12. American Academy of Dermatology Association. Rosacea treatment: How to treat the redness. Accessed April 13, 2022. https://www.aad.org/public/diseases/rosacea/treatment/redness

13. National Rosacea Society. Makeup for rosacea. Accessed April 13, 2022. https://www.rosacea.org/patients/makeup-for-rosacea

14. Cohen AF, Tiemstra JD. Diagnosis and treatment of rosacea. J Am Board Fam Pract. 2002;15(3):214-217.