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Systemic Therapy for Rosacea

Source: www.skintherapyletter.com
Topic: Rosacea
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Sort Desciption: To truly understand the effects of rosacea on patients, the psychosocial impact must be evaluated along with the visible aspects of this disease. ...

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To truly understand the effects of rosacea on patients, the psychosocial impact must be evaluated along with the visible aspects of this disease. For many of our patients, the stigma of a "drinker's nose" and the social and professional isolation that can result from low self-esteem is far more significant than the clinical reality.

Contributing to the frustration experienced by patients with rosacea is the fact that as clinicians, we do not truly treat rosacea, but rather manage it. We cannot offer patients cures, simply improvements. As with all chronic conditions, continual therapy inevitably leads to non-adherence. The benefits derived from a combination of both medical and psychological approaches cannot be overemphasized. The overall objective is the improvement of the quality of life of patients, and in 2007, this goal is easier to attain thanks to topical medications that reduce skin irritation. Furthermore, with the advent of safer, once-daily systemic medications, it is possible to liberate patients from the use of topical products.

Classification of Rosacea

Rosacea is a condition characterized by a constellation of symptoms including central facial erythema and telangiectasias, papules and pustules, granulomatous nodules, phyma formation, and ocular changes. The disorder is capricious with flares and remissions occurring without rationale. For the task of discussing therapy, rosacea is best viewed as a collection of several conditions with a common name. Although many patients have polymorphic disease, most have one predominating feature.

The most commonly used classification system is based on predominant lesion morphology and was developed by a committee of the National Rosacea Society and published in 2002. Patients are classified as having one of four types of rosacea: erythematotelangiectatic, papulopustular, phymatous, or ocular with a variant form referred to as granulomatous. Individual patients may straddle one or more subtypes, but this system allows us to determine therapy based on similar lesion types. Therapeutic options for the various lesion types are easily categorized and there are few medications or modalities that are significantly effective in more than one category.

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