Proceedings of the Fifth SKIN SPECTRUM SUMMIT

SSS-2019 02-10-20_Layout 1 2/12/2020 5:18 PM Page 30
ROSACEA
Treatment options for rosacea
Dr. Kevin Pehr
Although there is no lab test
to diagnose rosacea, there
are several treatment options,
which Dr. Kevin Pehr discussed
during his talk at Skin
Spectrum Summit in Montreal.
“If the patient understands
therapy-quality conditions, they’re
not expecting cure,” Dr. Pehr said.
“It is chronic. It is not adult acne.”
To begin with, Dr. Pehr recommends
asking questions to gain an
understanding of what is most worrisome
to the patient.
“Ask, ‘What aspect bothers you?
Is it the flushing? Is it the broken
blood vessels? Is it the itchy feel? Is
it the papules and pustules? Is it the
eyelids?’ Maybe they all bother the
patient, but find out what bothers
them the most and focus the treatment
on that to start,” he said.
When treating the nose area,
Dr. Pehr recommends spraying
oxymetazoline nasal spray on the
skin twice a day. The relatively inexpensive
treatment works about a
third of the time, according to Dr.
Pehr. Additionally, patients can use
brimonidine gel, an alpha-2 agonist,
which is applied in the morning and
works roughly 80% of the time. The
gel lasts about 12 to 13 hours before
wearing off.
For erythrotelangiectatic and
background erythema, Dr. Pehr suggests
laser therapy or intense
pulsed light, but cautions that this
treatment is expensive and is not
permanent.
There are various options when
it comes to treating papules and
pustules, including ivermectin,
which is expensive but effective.
Azelaic acid can be used for treatment
and is also good for post-inflammatory
hyperpigmentation but
can be a little irritating.
Although, in theory, low doses
of systemic antibiotics, such as
tretinoin or benzoyl peroxide, will
work for the treatment of papules
and pustules, Dr. Pehr avoids these
treatment options because they are
irritating for the patient.
With phyma, or bulging nose,
Dr. Pehr says isotretinoin may work
as a treatment option, but surgery
may be required.
When it comes to ocular
rosacea, Dr. Pehr says often patients
won’t think to ask their dermatologist
about the condition.
“Ask them about it,” he said.
“The patient will not volunteer. They
do not feel it is their business, especially
in my case. They say, ‘Well,
you’re a skin doctor; this is my eye
problem. Why say something to
you?’”
Dr. Pehr suggests that with
“good, hard treatment,” the patient
should see a response within the
first two months, but it could take
up to six months. It is important
that patients understand that the
treatment could clear their rosacea
symptoms for the rest of their life
but that they could also relapse
once the treatment stops.
Rosacea
management:
Early Dx
reduces
morbidities
Dr. Maha Dutil
Education and open dialogue
are crucial for doctors helping
their patient manage
rosacea symptoms, according to
Dr. Maha Dutil, who discussed
treatment options and things to
avoid during her talk on rosacea
management at Skin Spectrum
Summit in Toronto.
“Early diagnosis and treatment
will reduce morbidities,” Dr. Dutil
said. “Counsel on skin care, sun protection
and [avoiding] triggers. It
takes a lot of time, but unless [patients]
do all these things, your therapeutic
options do not work well.”
There are many topical treatments
available to patients, such as
metronidazole gel and 1% cream
30 • Proceedings of 2019 SKIN SPECTRUM SUMMIT