What are the guideline sources, guidelines and references for Rosacea ?
Guideline sources The following summarized guidelines for the evaluation and management of rosacea are prepared by our editorial team based on guidelines from the American Academy of Ophthalmology (AAO 2022), the British Association of Dermatologists (BAD 2021), and the Swiss Society of Dermatology and Venereology (SSDV 2017). 1 2 3 Guidelines 1. Classification and risk stratification Clinical classification: Use the classification of phenotypes identified by Gallo et al when characterizing the clinical subtypes and symptoms of rosacea which encompasses the objective clinical signs and the subjective symptoms experienced by the patient with rosacea. Recognize that diagnostic phenotypes include characteristic fixed centrofacial erythema or phymatous changes; other features include flushing, papules or pustules, telangiectasia, ocular changes, burning or stinging sensations, edema, and dryness. E Take into account the older classification system for rosacea which was based on clinical signs: erythematotelangiectatic, papulopustular, phymatous, or ocular. Characterize the clinical https://web.pathway.md/diseases/rec9ZmbFJVFaSf936 1/4 6/24/23, 2:57 PM Rosacea Pathway subtypes and symptoms of rosacea affecting the patient according to these clinical signs. E 2. Medical management Topical therapies: As per BAD 2021 guidelines, offer either ivermectin, metronidazole or azelaic acid as first-line topical treatment options in patients with papulopustular rosacea. Discuss the potential for irritancy of different products and formulations before prescribing the topical agent. A Show 2 more As per SSDV 2017 guidelines, offer brimonidine in patients with moderate-to-severe subtype I rosacea. A Show 4 more Systemic therapies: As per BAD 2021 guidelines, offer any of the following oral antibiotics as first-line treatment option in patients with more severe papulopustular rosacea: azithromycin clarithromycin doxycycline 40 mg (modified release) or 100 mg daily erythromycin lymecycline oxytetracycline. A Show 4 more As per SSDV 2017 guidelines, offer oral tetracyclines in patients with subtype II rosacea. A Show 5 more 3. Nonpharmacologic interventions Lifestyle modifications: advise limiting exposure to known aggravating factors such as alcohol, sun exposure, hot drinks, or spicy food in patients with rosacea. E Skin care: Advise washing skin with emollients, moisturizing regularly and using appropriate sun protection in patients with rosacea. Advise avoiding soaps and washing products containing detergent if they worsen the symptoms. E Consider advising skin camouflage in patients with rosacea having intractable erythema. E Psychological support: discuss the need for psychological support or psychiatric interventions in patients with rosacea experiencing anxiety or depression. Consider obtaining initial assessment in primary care. E https://web.pathway.md/diseases/rec9ZmbFJVFaSf936 2/4 6/24/23, 2:57 PM Rosacea Pathway 4. Therapeutic procedures Laser and intense pulsed light therapy: As per BAD 2021 guidelines, consider performing pulsed dye laser, Nd-YAG laser or intense pulse light in patients with rosacea where the main presenting feature is persistent facial erythema. Consult an appropriately qualified laser practitioner to ensure safe and high-quality practice. C As per SSDV 2017 guidelines: Offer intense pulsed light A , Nd-YAG or pulsed dye laser in patients with subtype I rosacea. B Consider offering neodymium-doped:yttrium-aluminum-garnet in patients with therapy- resistant subtype II rosacea. C Botulinum toxin injections: insufficient evidence to recommend botulinum toxin injections in patients with subtype I rosacea. I 5. Specific circumstances Patients with rhinophyma: consider performing nasal de-bulking in patients with significant rhinophyma by laser ablation or surgical intervention depending on local expertise. C Patients with ocular rosacea (nonpharmacologic management): advise minimizing exposure to aggravating factors (such as air conditioning, excessive central heating, smoky atmospheres, and periocular cosmetics) in patients with ocular rosacea. A Show 4 more Patients with ocular rosacea (pharmacotherapy): offer topical azelaic acid, topical ivermectin, topical brimonidine, oral doxycycline, or oral isotretinoin for blepharitis in patients with rosacea. B Patients with ocular rosacea (indications for referral): Refer patients with ocular rosacea to an ophthalmologist in case of: eye discomfort, sticky eye discharge persisting > 12 months despite frequent (> 6 times daily) topical lubricant use and adequate lid hygiene symptoms keeping the patient awake at night (such as reduced vision, pain on eye movement, and pain). A 6. Patient education Patient education: provide a patient information leaflet to patients with rosacea. E References https://web.pathway.md/diseases/rec9ZmbFJVFaSf936 3/4 6/24/23, 2:57 PM Rosacea Pathway 1. AAO PPP Cornea/External Disease Panel, Hoskins Center for Quality Eye Care. Cornea/External Disease Summary Benchmarks 2022. AAO. 2022 Dec. Open 2. P J Hampton, J Berth-Jones, C E Duarte Williamson et al. British Association of Dermatologists guidelines for the management of people with rosacea 2021. Br J Dermatol. 2021 May 15. Open 3. F Anzengruber, J Czernielewski, C Conrad et al. Swiss S1 guideline for the treatment of rosacea. J Eur Acad Dermatol Venereol. 2017 Nov;31 11 1775 1791. Open 4. Justin W Marson, Hilary E Baldwin. Rosacea: a wholistic review and update from pathogenesis to diagnosis and therapy. Int J Dermatol. 2020 Jun;59 6):e175-e182. Open 5. Mehdi Farshchian, Steven Daveluy. Rosacea. In: StatPearls Internet]. Treasure Island FL StatPearls Publishing; 2021 Jan. 2021 Jan 16. Open 6. Joerg Buddenkotte, Martin Steinhoff. Recent advances in understanding and managing rosacea. F1000Res. 2018 Dec 3;7 F1000 Faculty Rev-1885. Open 7. Roger Haber, Maria El Gemayel. Comorbidities in rosacea: A systematic review and update. J Am Acad Dermatol. 2018 Apr;78 4 786 792.e8. Open https://web.pathway.md/diseases/rec9ZmbFJVFaSf936 4/4