A recently published review investigated the role of skin-barrier impairment in rosacea and reduced symptomatology in patients when they used OTC skincare products. In the publication in the Journal of Drugs in Dermatology, nine dermatologists from the United States and Canada participated in a webinar to discuss evidence of barrier dysfunction in rosacea, the role of OTC skincare products in rosacea therapy, and optimal therapeutic regimens to treat the disease.
The article noted that breaking the cycle of inflammation that ultimately causes barrier dysfunction appears to be crucial in reducing rosacea symptoms. In an interview, lead author Hilary E. Baldwin, MD, medical director of The Acne Treatment and Research Center, Morristown, New Jersey; associate professor of clinical dermatology at Rutgers Robert Wood Johnson Medical Center, Piscataway, New Jersey; and head author of the study, stated, "Repeated episodes of flushing can lead to progressive damage of the endothelium, angiogenesis, as well as inflammatory changes in the dermis, leading to barrier dysfunction and exacerbation of rosacea disease."

Prior to the meeting, the physicians completed a survey on OTC skincare products recommended in their practice for patients with rosacea, including monotherapy, adjuncts to prescription medications, and maintenance therapy. Clinical guidelines, algorithms, and evidence-based recommendations for treatment of rosacea were collected from the literature through August 2020. The study panel considered moisturizers, cleansers, and ultraviolet protection. In addition to standard prescription medications, the panel's consensus was that the OTC products recommended for monotherapy include ceramide-containing cleansers and moisturizers, mineral sunscreens, redness creams, niacinamide-containing lotions, and azelaic acid 10%.

With regard to adjunctive therapy, the panel's selections consisted of facial cleansers and moisturizers with numerous ingredients. An estimated 37.5% of dermatologists recommended ceramide-containing skincare products and corrective gel. A cleanser and antiredness cream were recommended by 37.5%. An estimated 25% recommended a gentle cleanser, moisturizer with sun protection factor (SPF), or various types of serum. Examples of other OTC skincare products included forte cream and lotions containing vitamin Bs.

Additionally, the panel noted that their recommendations were the same for rosacea maintenance, with importance placed on continuing with products that were effective for the patient. In the study, the panel found that tackling barrier dysfunction by using moisturizer and cleanser formulations that restore skin hydration, normalize skin pH, and restore the microbiome and skin lipids can help improve rosacea signs and symptoms. The panel's consensus was that, in addition to the use of prescription medications, skincare recommendations are a crucial part of successful rosacea therapy.

In addition to occlusives and humectants, barrier-restoring ingredients such as ceramides, hyaluronic acid, and niacinamide were considered beneficial, and equally critical was the absence of potentially irritating substances. The panel concluded that the use of OTC products can improve rosacea symptomatology and signs, and as adjuncts, these products are recommended before and during prescription therapy and as part of a maintenance regimen.

Dr. Baldwin also stated, "No visit for rosacea is finished until you have discussed skincare with the patient. Physicians need to make sure that they get their patients on good-quality skincare that will help to repair the barrier and improve rosacea independent of pharmacologic therapy. In addition, physicians also need to ensure that patients avoid potential precipitating factors of the disease, including the use of high-pH soaps, exfoliants, and scrubs." Dr. Baldwin also observed, "In the past, OTC skincare in rosacea has not been given the attention it deserved. Now we are recognizing that it is at least half the battle."

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