Rosacea Information Gap Harms Patient Outcomes—How Compounding Pharmacists Can Help
Imagine if you developed acne—or thought you did—only to learn that you actually had non-curable rosacea. For months you may try different medications, seeking some therapy that works, all the time living with itching, burning, flushing and distress about your appearance. To make it worse, you can’t get straight answers about why rosacea is so hard to treat.
Unfortunately, this is the reality of many people with rosacea. The rosacea information gap harms patients as they continue to experiment with products that ultimately end up aggravating the condition. Compounding pharmacists can step in to offer expert guidance and help improve patient outcomes.
Patients Need Straightforward Communication
When researchers sorted through 2,705 messages posted on a forum for rosacea patients, they learned that forum members were brimming with questions about treatments, side effects and lifestyle concerns. Whether rosacea patients don’t get sufficient information from their physician or don’t understand what they’re told, communication clearly wasn’t adequate. So they turn to other, sometimes unreliable, resources and ultimately find voices of experience on the forum. Patient questions revolved around:1
- Treatment: Fifty percent had questions about treatment options and side effects. They’re especially concerned about antibiotics. It seems they don’t know that low doses reduce inflammation but pose little risk of side effects or antibiotic resistance.
- Skin care: Rosacea patients—12 percent of the participants—need assistance choosing skin care products.
- Triggers: Help identifying the triggers that exacerbate their rosacea weighed heavily on the minds of 17 percent of those on the forum.
- Diet: In this survey, 15 percent of the questions were about diet, which is only modified to remove triggers.
The number of people with questions about triggers and diet is a telling sign. It only takes simple guidance and a minimal investment of time to teach patients how to manage this facet of their rosacea. The fact that they still have questions about one of the most basic treatment principles reveals the dearth of communication.
Lifestyle and psychological Impact: People with rosacea often feel ashamed about their appearance, resulting in them curtailing social activities. This has been verified in other studies measuring quality of life. A meta-analysis published in March 2016 reported that rosacea diminishes quality of life so severely that it should be considered a vital medical problem. Yet a nationwide survey found that nearly half of rosacea patients aren’t comfortable talking to their physician about emotional challenges.2
Confusion over rosacea subtypes: Many patients didn’t understand the significance of subtypes. Their confusion is understandable. While the four diagnostic subtypes are well-defined, symptoms don’t always follow the guidelines. Facial flushing with burning and itching is one example. It’s the defining symptom of subtype 1, yet researchers found it also affects people in subtype 2.3
Pharmacists Bridge the Information Gap
One way or another, people with rosacea tend to become regulars at pharmacies. At first they may be looking to buy acne products because nearly half think they have acne. After they’re diagnosed, rosacea patients may have a prescription to fill. Then if the medication isn’t effective or causes side effects, they may stop using it and go back to the pharmacy in search of OTC treatments. Or they may not be able to afford meds and just head straight to the skin care aisle, shopping for basic cleansers and moisturizers that don’t burn or aggravate erythema. At each point in the process, these individuals need the guidance and expertise you can provide.
Pharmacists can also help patients understand triggers, which is critical because triggers must be avoided to control symptoms. The list of common triggers is deceivingly simple—it doesn’t hint at the trial-and-error it takes for each person to find their individual triggers. Some of the top culprits include:
- Environment: Sunlight, hot and cold temperatures, and wind are top triggers. Exposure to UV light is problematic because many sunscreens contain ingredients that aggravate rosacea.
- Emotional stress: Rosacea flare-ups are triggered by blood vessels in the skin modulated by sympathetic innervation.
- Hot or spicy foods
- Hot bath or sauna
- Intense exercise
- Cosmetics and skin care products
Encourage patients to keep a diary for several weeks, noting food, activities, weather, medications used and rosacea status. Reviewing the diary makes it easier to recognize trigger patterns. The National Rosacea Society offers free booklets with easy-to-use forms that track all the info.4
Basic skin care: It’s recommended that patients with rosacea regularly wear a sunscreen and be meticulous about facial skin care, but they seldom receive specific advice about choosing products. Then some discover that the products they buy—including rosacea-specific products—irritate their skin and cause a flare up. To further complicate the issue, they may have dry or oily skin. There’s no one-size-fits-all product.
- As a pharmacist, you can help patients choose the best OTC product or work with them to develop a compounded facial cream that restores the skin’s natural barrier, yet doesn’t contain alcohol, fragrances or other irritating ingredients.
Overview of Rosacea Treatment Options
The best results are achieved with a combination of pharmaceutical, laser and light therapies. Each rosacea subtype has its own preferred pharmaceuticals, but most patients go through multiple frustrating trials to find the combination of therapies that work best for them.5 The list of potential treatments includes:6
- Topical FDA-approved: Brimonidine tartrate gel, oxymetazoline, metronidazole, azelaic acid, ivermectin
- Topical off-label: Calcineurin inhibitors, permethrin, benzoyl peroxide
- Systemic: Doxycycline 40 mg, isotretinoin
- For telangiectasia and erythema: Pulsed dye laser, intense pulsed light (IPL)
When prescription treatments don’t work, patients often turn to natural products. One randomized, controlled trial found that a mixture made from 90 percent medical-grade kanuka honey and 10 percent glycerin significantly improved rosacea symptoms in one-third of the participants.7 Hyaluronic acid sodium salt 0.2 percent cream and 4 percent Quassia amara extract topical gel also brought symptom improvement. Other natural ingredients with hydrating and anti-inflammatory properties include colloidal oatmeal, niacinamide, feverfew, aloe vera, chamomile and mushroom extracts.
Information Improves Outcomes for Rosacea Patients
Rosacea is a challenge to diagnose and treat—lack of information only makes it more frustrating for patients seeking answers. Compounding pharmacists have the best opportunity and the perfect expertise to reach out and help patients understand the process, find the most effective products and offer compounded options that may deliver the precise relief patients need.
Pharmaceutica North America provides high-quality bulk APIs, custom compounding kits and emollient delivery systems for pharmacists and physicians. Contact us to talk about how we can help you provide the highest level of care for your patients.
- “Rosacea Patients Seeking Advice: Qualitative Analysis of Patients’ Posts on a Rosacea Support Forum,” March 2016, http://www.ncbi.nlm.nih.gov/pubmed/26815357 ↩
- “It’s Rosacea, Not Acne,” July 2015, http://dermatologytimes.modernmedicine.com/dermatology-times/news/its-rosacea-not-acne ↩
- “Study Finds Evidence for Rosacea Subtype Progression,” January 2014, http://dermatologytimes.modernmedicine.com/dermatology-times/rc/tags/dermatology/study-finds-evidence-rosacea-subtype-progression ↩
- “Rosacea Diary Booklet,” 2016, http://www.rosacea.org/patients/materials/diary/index.php ↩
- “Update on the Management of Rosacea,” April 2015, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396587/ ↩
- “Rosacea: A New Crop of Treatments,” May 2016, http://www.pharmacytimes.com/publications/issue/2016/may2016/rosacea-a-new-crop-of-treatments ↩
- “Randomised Controlled Trial of Topical Kanuka Honey for the Treatment of Rosacea, June 2015, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4480029/ ↩