Consensus on the therapeutic management of rosacea – Brazilian Society of Dermatology

Abstract

Background Rosacea is a chronic inflammatory disease of the skin, relatively more frequent in women over 30 with a low phototype and proven genetic predisposition. Although its etiology is unknown and possibly multifactorial, the immunological abnormality, associated with neurovascular dysregulation and triggering factors, are important elements in its pathophysiology, which lead to the main changes of inflammation, vasodilation, and angiogenesis that are responsible for the clinical manifestations. Despite the lack of cure, numerous therapeutic options are available for the different clinical presentations of the disease, with satisfactory responses. Objective To reach a consensus, with recommendations from experts, on the therapeutic management of rosacea suitable to the Brazilian setting. Methods The study was conducted by five specialized dermatologists from university centers, representatives of the different Brazilian regions, with experience in rosacea, who were appointed by the Brazilian Society of Dermatology. Based on the adapted DELPHI methodology, the experts contributed through an updated bibliographic review of the scientific evidence, combined with personal experiences. Results The group of experts reached a consensus on the relevant aspects in the therapeutic management of rosacea, providing information on epidemiology, pathophysiology, triggering factors, clinical condition, classification, quality of life, and comorbidities. Consensus was defined as approval by at least 90% of the panel. Conclusion Despite the impossibility of cure, there are several therapeutic alternatives specific to each patient that provide excellent results, with chances of total improvement and long periods of remission, promoting a positive impact on quality of life. This consensus provides detailed guidance for clinical practice and therapeutic decisions in rosacea.

Treatment and Maintenance of Cutaneous Rosacea in Latino Skin Types With Prescription Medications and Non-Prescription Cleansers and Moisturizers as Adjuncts: A Review

“…The Brazilian consensus recommendations are similar to ROSCO recommendations with one notable exception: the use of botulinum toxin as treatment for erythema and flushing. 16 This approach is supported by studies showing the neuromodulator function of botulinum toxin may positively improve erythematous rosacea symptoms by blunting neurovascular instability and reducing inflammationrelated mast cell degranulation. [27][28][29] Treatment for Papulopustular Rosacea Systematic reviews 5,6,11 of treatment for inflammatory papules and pustules have identified effective therapy with topical ivermectin, azelaic acid, and metronidazole.…”

“…15 The Brazilian Society of Dermatology has published a detailed consensus covering rosacea treatment without reporting that nation's rosacea prevalence. 16 Climate variations can affect symptoms. Global reports indicate a correlation between rosacea, increased sun exposure, and hotter climates.…”

Quality of life measurement in rosacea. Position statement of the European Academy of Dermatology and Venereology Task Forces on Quality of Life and Patient Oriented Outcomes and Acne, Rosacea and Hidradenitis Suppurativa

“…Available consensus documents and guidelines recommend HRQoL measurement and recognize that improvement of HRQoL is an important treatment goal in patients with rosacea. [17][18][19] The purpose of this paper organized jointly by the European Academy of Dermatology and Venereology (EADV) Task Force (TF) on QoL and Patient-Oriented Outcomes and the EADV TF on Acne, Rosacea and Hidradenitis Suppurativa (ARHS) is to present current knowledge about QoL assessment in rosacea, including data on rosacea-specific HRQoL instruments and influence of different treatment methods on HRQoL, and to make practical recommendations concerning the assessment of QoL in people with rosacea.…”

“…Therefore, it is important to develop guidelines and consensus about the management of the disease, which may vary in different countries based on different environments and health systems. Available consensus documents and guidelines recommend HRQoL measurement and recognize that improvement of HRQoL is an important treatment goal in patients with rosacea 17–19 …”

Long‐term maintenance treatment of rosacea: experts' opinion

“…In some cases, other oral antibiotics, isotretinoin, and physical technologies such as lasers and light therapies can also be used. 10,11 As a chronic disease, rosacea is treated with different approaches depending on the disease evolution. Treatment phases are initiation, modification/adjustment, maintenance, and discontinuation.…”