Rosacea

Internet-based patient education sessions – specifically, “virtual counseling” – appear to be an effective method of improving general knowledge about acne among adolescents, according to Mr. William Tuong and his associates.

To compare the effectiveness of approaches in improving patient knowledge of acne vulgaris, the researchers instructed 97 high school students to visit either a standard website or an automated counseling website to learn about acne, and submit a multiple-choice questionnaire designed to assess any changes in acne knowledge.

Both groups demonstrated significantly improved knowledge after a 12-week follow-up, although the automated counseling website group rated the educational material more useful and more enjoyable to view than did the standard website group.

Read the full article at American Journal of Clinical Dermatology (2015;55-60 [doi:10.1007/s40257-014-0104-6]).

[email protected]

Internet-based patient education sessions – specifically, “virtual counseling” – appear to be an effective method of improving general knowledge about acne among adolescents, according to Mr. William Tuong and his associates.

To compare the effectiveness of approaches in improving patient knowledge of acne vulgaris, the researchers instructed 97 high school students to visit either a standard website or an automated counseling website to learn about acne, and submit a multiple-choice questionnaire designed to assess any changes in acne knowledge.

Both groups demonstrated significantly improved knowledge after a 12-week follow-up, although the automated counseling website group rated the educational material more useful and more enjoyable to view than did the standard website group.

Read the full article at American Journal of Clinical Dermatology (2015;55-60 [doi:10.1007/s40257-014-0104-6]).

[email protected]

Internet-based patient education sessions – specifically, “virtual counseling” – appear to be an effective method of improving general knowledge about acne among adolescents, according to Mr. William Tuong and his associates.

To compare the effectiveness of approaches in improving patient knowledge of acne vulgaris, the researchers instructed 97 high school students to visit either a standard website or an automated counseling website to learn about acne, and submit a multiple-choice questionnaire designed to assess any changes in acne knowledge.

Both groups demonstrated significantly improved knowledge after a 12-week follow-up, although the automated counseling website group rated the educational material more useful and more enjoyable to view than did the standard website group.

Read the full article at American Journal of Clinical Dermatology (2015;55-60 [doi:10.1007/s40257-014-0104-6]).

[email protected]

Intradermal injection of botulinum toxin was an effective and safe method of treating facial erythema of rosacea, according to Dr. Bradley Bloom, of the Laser & Skin Surgery Center of New York, and his associates.

Of 15 patients, the mean baseline erythema grade was 1.8, and the mean erythema grade at 3 months after treatment was 1. The treatment resulted in statistically significant improvement in erythema at 1, 2, and 3 months after treatment when compared with baseline, according to the researchers. The patients were of Fitzpatrick skin Types I to III with a mean age of 54 years, and 80% were women

Because of the promising results, further and more extensive trials are recommended, but further investigation is needed to elucidate the mechanism of action by which botulinum toxin improves facial flushing of rosacea, the researchers said.

Read the full article at Dermatologic Surgery (doi: 10.1097/DSS.0000000000000277).

Intradermal injection of botulinum toxin was an effective and safe method of treating facial erythema of rosacea, according to Dr. Bradley Bloom, of the Laser & Skin Surgery Center of New York, and his associates.

Of 15 patients, the mean baseline erythema grade was 1.8, and the mean erythema grade at 3 months after treatment was 1. The treatment resulted in statistically significant improvement in erythema at 1, 2, and 3 months after treatment when compared with baseline, according to the researchers. The patients were of Fitzpatrick skin Types I to III with a mean age of 54 years, and 80% were women

Because of the promising results, further and more extensive trials are recommended, but further investigation is needed to elucidate the mechanism of action by which botulinum toxin improves facial flushing of rosacea, the researchers said.

Read the full article at Dermatologic Surgery (doi: 10.1097/DSS.0000000000000277).

Intradermal injection of botulinum toxin was an effective and safe method of treating facial erythema of rosacea, according to Dr. Bradley Bloom, of the Laser & Skin Surgery Center of New York, and his associates.

Of 15 patients, the mean baseline erythema grade was 1.8, and the mean erythema grade at 3 months after treatment was 1. The treatment resulted in statistically significant improvement in erythema at 1, 2, and 3 months after treatment when compared with baseline, according to the researchers. The patients were of Fitzpatrick skin Types I to III with a mean age of 54 years, and 80% were women

Because of the promising results, further and more extensive trials are recommended, but further investigation is needed to elucidate the mechanism of action by which botulinum toxin improves facial flushing of rosacea, the researchers said.

Read the full article at Dermatologic Surgery (doi: 10.1097/DSS.0000000000000277).

ORLANDO – A non-resorbable wrinkle filler proved highly effective and durable for the treatment of atrophic acne scars in a randomized, controlled, multicenter study.

At 1 month after treatment with polymethylmethacrylate-collagen, or PMMA-collagen (Artefill, Suneva Medical, Inc.), nearly 70% of 97 subjects showed at least a 2-point improvement on the validated 4-point Acne Scar Rating Scale, compared with about 40% of 50 control subjects injected with saline. At 6 months, the response rate remained above 60% in the PMMA-collagen group, but dropped closer to 30% among those in the control group, Dr. James M. Spencer of Mount Sinai School of Medicine, New York reported in a poster at the Orlando Dermatology Aesthetic and Clinical Conference.

© Ocskay Bence /Fotolia.com

The control group subjects were then crossed over to the treatment group, and, at 12 months, the response rates were about 70% and nearly 60% in the treatment and control groups, respectively, he said.

Similarly, both Physician and Subject Global Aesthetic Improvement Scale (PGAIS/SGAIS) scores diverged during a 6-month evaluator-blinded phase of the study, then converged after crossover by the control group subjects. For example, the percentage of treatment and control group subjects with improvement at 1 month and 6 months according to the 5-point PGAIS was about 90% vs. less than 65%, and about 80% vs. about 30%, respectively. More than 90% in both groups showed improvement at 12 months, after control group crossover.

Additionally, subject satisfaction at 1 and 6 months in the treatment and control groups based on assessment of scar correction using Patient Satisfaction Scale scores was above 80% vs. about 60%, and about 80% vs. about 50%, respectively. Satisfaction in both groups was between 80% and 90% at 12 months, after control group crossover.

Study subjects, who had a mean age of 44 years, were enrolled from 10 U.S. centers and were treated during one injection session. An additional touch-up injection was allowed as needed. A total of 1,292 scars were treated in the 97 treatment group subjects, and 424 were treated in the 50 control group subjects. Participants were evaluated by blinded assessors at 2 weeks and 1, 3, and 6 months, after which control group subjects were treated with PMMA-collagen. Assessments were made in open-label fashion at 9 and 12 months. Most subjects (61%) were women, and 20% had Fitzpatrick skin types 5 or 6.

During the blinded portion of the study, six treatment-related adverse events were reported among treatment group subjects, and two were reported among control group subjects. None of the subjects experienced granulomas, changes in pigmentation, or hypertrophic scarring.

This study is the first randomized, blinded study of PMMA-collagen for treating acne scars, Dr. Spencer noted, adding that the findings demonstrate the efficacy and safety of PMMA-collagen for this purpose.

“The improvement is durable, lasting for 12 months,” he wrote, noting that the filler is easily administered and requires minimal training in those who are familiar with dermal fillers.

“PMMA-collagen works very well on deep, severe acne scars, and should also work very well on shallow scars,” he said.

The product may enable practitioners to effectively treat acne scarring without a large capital equipment expenditure and without the risks associated with resurfacing procedures,” he said.

This study was sponsored by Suneva Medical, Inc.

ORLANDO – A non-resorbable wrinkle filler proved highly effective and durable for the treatment of atrophic acne scars in a randomized, controlled, multicenter study.

At 1 month after treatment with polymethylmethacrylate-collagen, or PMMA-collagen (Artefill, Suneva Medical, Inc.), nearly 70% of 97 subjects showed at least a 2-point improvement on the validated 4-point Acne Scar Rating Scale, compared with about 40% of 50 control subjects injected with saline. At 6 months, the response rate remained above 60% in the PMMA-collagen group, but dropped closer to 30% among those in the control group, Dr. James M. Spencer of Mount Sinai School of Medicine, New York reported in a poster at the Orlando Dermatology Aesthetic and Clinical Conference.

© Ocskay Bence /Fotolia.com

The control group subjects were then crossed over to the treatment group, and, at 12 months, the response rates were about 70% and nearly 60% in the treatment and control groups, respectively, he said.

Similarly, both Physician and Subject Global Aesthetic Improvement Scale (PGAIS/SGAIS) scores diverged during a 6-month evaluator-blinded phase of the study, then converged after crossover by the control group subjects. For example, the percentage of treatment and control group subjects with improvement at 1 month and 6 months according to the 5-point PGAIS was about 90% vs. less than 65%, and about 80% vs. about 30%, respectively. More than 90% in both groups showed improvement at 12 months, after control group crossover.

Additionally, subject satisfaction at 1 and 6 months in the treatment and control groups based on assessment of scar correction using Patient Satisfaction Scale scores was above 80% vs. about 60%, and about 80% vs. about 50%, respectively. Satisfaction in both groups was between 80% and 90% at 12 months, after control group crossover.

Study subjects, who had a mean age of 44 years, were enrolled from 10 U.S. centers and were treated during one injection session. An additional touch-up injection was allowed as needed. A total of 1,292 scars were treated in the 97 treatment group subjects, and 424 were treated in the 50 control group subjects. Participants were evaluated by blinded assessors at 2 weeks and 1, 3, and 6 months, after which control group subjects were treated with PMMA-collagen. Assessments were made in open-label fashion at 9 and 12 months. Most subjects (61%) were women, and 20% had Fitzpatrick skin types 5 or 6.

During the blinded portion of the study, six treatment-related adverse events were reported among treatment group subjects, and two were reported among control group subjects. None of the subjects experienced granulomas, changes in pigmentation, or hypertrophic scarring.

This study is the first randomized, blinded study of PMMA-collagen for treating acne scars, Dr. Spencer noted, adding that the findings demonstrate the efficacy and safety of PMMA-collagen for this purpose.

“The improvement is durable, lasting for 12 months,” he wrote, noting that the filler is easily administered and requires minimal training in those who are familiar with dermal fillers.

“PMMA-collagen works very well on deep, severe acne scars, and should also work very well on shallow scars,” he said.

The product may enable practitioners to effectively treat acne scarring without a large capital equipment expenditure and without the risks associated with resurfacing procedures,” he said.

This study was sponsored by Suneva Medical, Inc.

ORLANDO – A non-resorbable wrinkle filler proved highly effective and durable for the treatment of atrophic acne scars in a randomized, controlled, multicenter study.

At 1 month after treatment with polymethylmethacrylate-collagen, or PMMA-collagen (Artefill, Suneva Medical, Inc.), nearly 70% of 97 subjects showed at least a 2-point improvement on the validated 4-point Acne Scar Rating Scale, compared with about 40% of 50 control subjects injected with saline. At 6 months, the response rate remained above 60% in the PMMA-collagen group, but dropped closer to 30% among those in the control group, Dr. James M. Spencer of Mount Sinai School of Medicine, New York reported in a poster at the Orlando Dermatology Aesthetic and Clinical Conference.

© Ocskay Bence /Fotolia.com

The control group subjects were then crossed over to the treatment group, and, at 12 months, the response rates were about 70% and nearly 60% in the treatment and control groups, respectively, he said.

Similarly, both Physician and Subject Global Aesthetic Improvement Scale (PGAIS/SGAIS) scores diverged during a 6-month evaluator-blinded phase of the study, then converged after crossover by the control group subjects. For example, the percentage of treatment and control group subjects with improvement at 1 month and 6 months according to the 5-point PGAIS was about 90% vs. less than 65%, and about 80% vs. about 30%, respectively. More than 90% in both groups showed improvement at 12 months, after control group crossover.

Additionally, subject satisfaction at 1 and 6 months in the treatment and control groups based on assessment of scar correction using Patient Satisfaction Scale scores was above 80% vs. about 60%, and about 80% vs. about 50%, respectively. Satisfaction in both groups was between 80% and 90% at 12 months, after control group crossover.

Study subjects, who had a mean age of 44 years, were enrolled from 10 U.S. centers and were treated during one injection session. An additional touch-up injection was allowed as needed. A total of 1,292 scars were treated in the 97 treatment group subjects, and 424 were treated in the 50 control group subjects. Participants were evaluated by blinded assessors at 2 weeks and 1, 3, and 6 months, after which control group subjects were treated with PMMA-collagen. Assessments were made in open-label fashion at 9 and 12 months. Most subjects (61%) were women, and 20% had Fitzpatrick skin types 5 or 6.

During the blinded portion of the study, six treatment-related adverse events were reported among treatment group subjects, and two were reported among control group subjects. None of the subjects experienced granulomas, changes in pigmentation, or hypertrophic scarring.

This study is the first randomized, blinded study of PMMA-collagen for treating acne scars, Dr. Spencer noted, adding that the findings demonstrate the efficacy and safety of PMMA-collagen for this purpose.

“The improvement is durable, lasting for 12 months,” he wrote, noting that the filler is easily administered and requires minimal training in those who are familiar with dermal fillers.

“PMMA-collagen works very well on deep, severe acne scars, and should also work very well on shallow scars,” he said.

The product may enable practitioners to effectively treat acne scarring without a large capital equipment expenditure and without the risks associated with resurfacing procedures,” he said.

This study was sponsored by Suneva Medical, Inc.

ORLANDO – A three-component combined over-the-counter and prescription skin care regimen was safe, effective, well tolerated, and well liked by acne vulgaris patients aged 12 years and older in an open-label multicenter study.

Of 81 participants with a mean age of 19 years, mild or moderate facial acne vulgaris, and mean acne vulgaris duration of 4.4 years, 89.2% agreed or strongly agreed that they liked the regimen, 87.9% reported overall satisfaction, and 87.9% said they would recommend the regimen to others.

Nearly all participants (95.9%) said the regimen was easy to use, 73% reported improved skin texture, and 70.3% said the regimen met their needs, Dr. Michael H. Gold of Nashville, Tenn., reported in a poster at the Orlando Dermatology Aesthetic and Clinical Conference.

Treatment involved once-daily application of a prescription topical gel containing adapalene 1% and benzoyl peroxide 2.5%, as well as the use of two over-the-counter products designed for acne-prone skin: a foaming cleanser used twice daily and a moisturizer with broad spectrum SPF 30 sunscreen used once daily. Treatment continued for 8 weeks.

In addition to the subjective patient satisfaction questionnaire, subjects were assessed based on total inflammatory and noninflammatory lesion counts; photographic evaluation of skin shininess, texture, and presence of Propionibacterium acnes; cutaneous tolerability scores for stinging, burning, erythema, scaling, and dryness; and adverse events.

© Stephen Strathdee/ iStockphoto.com

The therapeutic effect was evident in most patients at 2 weeks, with a reduction in the number of lesions. After 8 weeks, total inflammatory and noninflammatory lesion counts were significantly reduced, compared with baseline. Skin shininess and P. acnes also were significantly reduced by 8 weeks, Dr. Gold noted.

Most patients had no cutaneous irritation; the proportion of patients experiencing irritation was smaller than in prior phase II and III studies that evaluated benzoyl peroxide once-daily gel with or without moisturizer. Of 553 patients from those prior studies, 4% and 1% reported moderate and severe erythema, respectively, compared with 1% and 0% of the patients in the current study. In addition 3% and 1% of patients in earlier phase II and III studies, respectively, reported moderate or severe stinging/burning, compared with none of the patients in the current study.

A total of 18 adverse events were reported by 13 patients in the current study, and 17 events were considered to be related to the skin care regimen. None of the affected patients discontinued the regimen, and none of the patients reported serious adverse events.

Of note, 70% of patients agreed or strongly agreed that a sunscreen made for acne-prone skin was important to them, Dr. Gold said.

He and his colleagues concluded that a complete three-component, acne-specific regimen designed to clean, moisturize, medicate, and photoprotect is important for optimizing patient outcomes, and that the regimen used in this study was associated with good outcomes and high levels of patient satisfaction.

This study was funded by Galderma Laboratories.

[email protected]

ORLANDO – A three-component combined over-the-counter and prescription skin care regimen was safe, effective, well tolerated, and well liked by acne vulgaris patients aged 12 years and older in an open-label multicenter study.

Of 81 participants with a mean age of 19 years, mild or moderate facial acne vulgaris, and mean acne vulgaris duration of 4.4 years, 89.2% agreed or strongly agreed that they liked the regimen, 87.9% reported overall satisfaction, and 87.9% said they would recommend the regimen to others.

Nearly all participants (95.9%) said the regimen was easy to use, 73% reported improved skin texture, and 70.3% said the regimen met their needs, Dr. Michael H. Gold of Nashville, Tenn., reported in a poster at the Orlando Dermatology Aesthetic and Clinical Conference.

Treatment involved once-daily application of a prescription topical gel containing adapalene 1% and benzoyl peroxide 2.5%, as well as the use of two over-the-counter products designed for acne-prone skin: a foaming cleanser used twice daily and a moisturizer with broad spectrum SPF 30 sunscreen used once daily. Treatment continued for 8 weeks.

In addition to the subjective patient satisfaction questionnaire, subjects were assessed based on total inflammatory and noninflammatory lesion counts; photographic evaluation of skin shininess, texture, and presence of Propionibacterium acnes; cutaneous tolerability scores for stinging, burning, erythema, scaling, and dryness; and adverse events.

© Stephen Strathdee/ iStockphoto.com

The therapeutic effect was evident in most patients at 2 weeks, with a reduction in the number of lesions. After 8 weeks, total inflammatory and noninflammatory lesion counts were significantly reduced, compared with baseline. Skin shininess and P. acnes also were significantly reduced by 8 weeks, Dr. Gold noted.

Most patients had no cutaneous irritation; the proportion of patients experiencing irritation was smaller than in prior phase II and III studies that evaluated benzoyl peroxide once-daily gel with or without moisturizer. Of 553 patients from those prior studies, 4% and 1% reported moderate and severe erythema, respectively, compared with 1% and 0% of the patients in the current study. In addition 3% and 1% of patients in earlier phase II and III studies, respectively, reported moderate or severe stinging/burning, compared with none of the patients in the current study.

A total of 18 adverse events were reported by 13 patients in the current study, and 17 events were considered to be related to the skin care regimen. None of the affected patients discontinued the regimen, and none of the patients reported serious adverse events.

Of note, 70% of patients agreed or strongly agreed that a sunscreen made for acne-prone skin was important to them, Dr. Gold said.

He and his colleagues concluded that a complete three-component, acne-specific regimen designed to clean, moisturize, medicate, and photoprotect is important for optimizing patient outcomes, and that the regimen used in this study was associated with good outcomes and high levels of patient satisfaction.

This study was funded by Galderma Laboratories.

[email protected]

ORLANDO – A three-component combined over-the-counter and prescription skin care regimen was safe, effective, well tolerated, and well liked by acne vulgaris patients aged 12 years and older in an open-label multicenter study.

Of 81 participants with a mean age of 19 years, mild or moderate facial acne vulgaris, and mean acne vulgaris duration of 4.4 years, 89.2% agreed or strongly agreed that they liked the regimen, 87.9% reported overall satisfaction, and 87.9% said they would recommend the regimen to others.

Nearly all participants (95.9%) said the regimen was easy to use, 73% reported improved skin texture, and 70.3% said the regimen met their needs, Dr. Michael H. Gold of Nashville, Tenn., reported in a poster at the Orlando Dermatology Aesthetic and Clinical Conference.

Treatment involved once-daily application of a prescription topical gel containing adapalene 1% and benzoyl peroxide 2.5%, as well as the use of two over-the-counter products designed for acne-prone skin: a foaming cleanser used twice daily and a moisturizer with broad spectrum SPF 30 sunscreen used once daily. Treatment continued for 8 weeks.

In addition to the subjective patient satisfaction questionnaire, subjects were assessed based on total inflammatory and noninflammatory lesion counts; photographic evaluation of skin shininess, texture, and presence of Propionibacterium acnes; cutaneous tolerability scores for stinging, burning, erythema, scaling, and dryness; and adverse events.

© Stephen Strathdee/ iStockphoto.com

The therapeutic effect was evident in most patients at 2 weeks, with a reduction in the number of lesions. After 8 weeks, total inflammatory and noninflammatory lesion counts were significantly reduced, compared with baseline. Skin shininess and P. acnes also were significantly reduced by 8 weeks, Dr. Gold noted.

Most patients had no cutaneous irritation; the proportion of patients experiencing irritation was smaller than in prior phase II and III studies that evaluated benzoyl peroxide once-daily gel with or without moisturizer. Of 553 patients from those prior studies, 4% and 1% reported moderate and severe erythema, respectively, compared with 1% and 0% of the patients in the current study. In addition 3% and 1% of patients in earlier phase II and III studies, respectively, reported moderate or severe stinging/burning, compared with none of the patients in the current study.

A total of 18 adverse events were reported by 13 patients in the current study, and 17 events were considered to be related to the skin care regimen. None of the affected patients discontinued the regimen, and none of the patients reported serious adverse events.

Of note, 70% of patients agreed or strongly agreed that a sunscreen made for acne-prone skin was important to them, Dr. Gold said.

He and his colleagues concluded that a complete three-component, acne-specific regimen designed to clean, moisturize, medicate, and photoprotect is important for optimizing patient outcomes, and that the regimen used in this study was associated with good outcomes and high levels of patient satisfaction.

This study was funded by Galderma Laboratories.

[email protected]

ORLANDO – An over-the-counter 5.5% benzoyl peroxide preparation with lipohydroxy acid was a safe and effective alternative to prescription 5% benzoyl peroxide with 1% clindamycin in a 12-week randomized, double-blind, multicenter study of patients with mild to moderate acne vulgaris who also were treated with generic 0.025% tretinoin.

Statistically significant improvement on a variety of efficacy endpoints was seen at weeks 8 and 12 in 60 men and women aged 18-50 years who were randomized to either the OTC-based or prescription-based regimen, Susana Raab of L’Oreal Research & Innovation, Clark, N.J., reported in a poster at the Orlando Dermatology Aesthetic and Clinical Conference.

Courtesy Wikimedia Commons/Kinan Ayu/Creative Commons license

The mean reduction in total acne lesion count at week 8 was approximately 60% with the OTC regimen and 64% in the prescription regimen. At week 12, the mean reduction was about 72% in both groups. The mean improvement in global acne assessment was approximately 31% and 33% in the groups, respectively, at 8 weeks, and about 33% in both groups at 12 weeks.

The mean improvement in overall appearance was 37%-38% in both groups at 8 weeks, and was close to 50% in both groups at 12 weeks, Ms. Raab said.

All skin types and a range of ethnicities were represented in the study population. Subjects applied the OTC benzoyl peroxide with lipohydroxy acid or the prescription benzoyl peroxide and clindamycin twice daily for 12 weeks. The tretinoin was applied daily at night after the other products were dried and absorbed. Three blinded board-certified dermatologists assessed the subjects for tolerability, and lesion counts were performed on the entire face to assess for open and closed comedones, papules, and pustules.

The dermatologists also assessed for tone, smoothness, brightness, appearance of pores, global acne, overall skin appearance, and tolerability.

The degree of acne relapse was assessed during a 4-week regression phase at which time the treatment was discontinued.

Both treatments improved inflammatory and noninflammatory lesions to a similar degree within 2 weeks of use. Dryness and peeling were seen with both treatments, but resolved by week 12. Stinging, tingling, itching, and burning also were common with both treatments, and largely resolved in both groups by week 8, except for significant stinging in the OTC treatment group. No significant overall differences were seen between the groups with respect to tolerance parameters, Ms. Raab noted.

“When compared, both treatments were at parity in improvement of all efficacy attributes at all time points,” she and her colleagues concluded.

ORLANDO – An over-the-counter 5.5% benzoyl peroxide preparation with lipohydroxy acid was a safe and effective alternative to prescription 5% benzoyl peroxide with 1% clindamycin in a 12-week randomized, double-blind, multicenter study of patients with mild to moderate acne vulgaris who also were treated with generic 0.025% tretinoin.

Statistically significant improvement on a variety of efficacy endpoints was seen at weeks 8 and 12 in 60 men and women aged 18-50 years who were randomized to either the OTC-based or prescription-based regimen, Susana Raab of L’Oreal Research & Innovation, Clark, N.J., reported in a poster at the Orlando Dermatology Aesthetic and Clinical Conference.

Courtesy Wikimedia Commons/Kinan Ayu/Creative Commons license

The mean reduction in total acne lesion count at week 8 was approximately 60% with the OTC regimen and 64% in the prescription regimen. At week 12, the mean reduction was about 72% in both groups. The mean improvement in global acne assessment was approximately 31% and 33% in the groups, respectively, at 8 weeks, and about 33% in both groups at 12 weeks.

The mean improvement in overall appearance was 37%-38% in both groups at 8 weeks, and was close to 50% in both groups at 12 weeks, Ms. Raab said.

All skin types and a range of ethnicities were represented in the study population. Subjects applied the OTC benzoyl peroxide with lipohydroxy acid or the prescription benzoyl peroxide and clindamycin twice daily for 12 weeks. The tretinoin was applied daily at night after the other products were dried and absorbed. Three blinded board-certified dermatologists assessed the subjects for tolerability, and lesion counts were performed on the entire face to assess for open and closed comedones, papules, and pustules.

The dermatologists also assessed for tone, smoothness, brightness, appearance of pores, global acne, overall skin appearance, and tolerability.

The degree of acne relapse was assessed during a 4-week regression phase at which time the treatment was discontinued.

Both treatments improved inflammatory and noninflammatory lesions to a similar degree within 2 weeks of use. Dryness and peeling were seen with both treatments, but resolved by week 12. Stinging, tingling, itching, and burning also were common with both treatments, and largely resolved in both groups by week 8, except for significant stinging in the OTC treatment group. No significant overall differences were seen between the groups with respect to tolerance parameters, Ms. Raab noted.

“When compared, both treatments were at parity in improvement of all efficacy attributes at all time points,” she and her colleagues concluded.

ORLANDO – An over-the-counter 5.5% benzoyl peroxide preparation with lipohydroxy acid was a safe and effective alternative to prescription 5% benzoyl peroxide with 1% clindamycin in a 12-week randomized, double-blind, multicenter study of patients with mild to moderate acne vulgaris who also were treated with generic 0.025% tretinoin.

Statistically significant improvement on a variety of efficacy endpoints was seen at weeks 8 and 12 in 60 men and women aged 18-50 years who were randomized to either the OTC-based or prescription-based regimen, Susana Raab of L’Oreal Research & Innovation, Clark, N.J., reported in a poster at the Orlando Dermatology Aesthetic and Clinical Conference.

Courtesy Wikimedia Commons/Kinan Ayu/Creative Commons license

The mean reduction in total acne lesion count at week 8 was approximately 60% with the OTC regimen and 64% in the prescription regimen. At week 12, the mean reduction was about 72% in both groups. The mean improvement in global acne assessment was approximately 31% and 33% in the groups, respectively, at 8 weeks, and about 33% in both groups at 12 weeks.

The mean improvement in overall appearance was 37%-38% in both groups at 8 weeks, and was close to 50% in both groups at 12 weeks, Ms. Raab said.

All skin types and a range of ethnicities were represented in the study population. Subjects applied the OTC benzoyl peroxide with lipohydroxy acid or the prescription benzoyl peroxide and clindamycin twice daily for 12 weeks. The tretinoin was applied daily at night after the other products were dried and absorbed. Three blinded board-certified dermatologists assessed the subjects for tolerability, and lesion counts were performed on the entire face to assess for open and closed comedones, papules, and pustules.

The dermatologists also assessed for tone, smoothness, brightness, appearance of pores, global acne, overall skin appearance, and tolerability.

The degree of acne relapse was assessed during a 4-week regression phase at which time the treatment was discontinued.

Both treatments improved inflammatory and noninflammatory lesions to a similar degree within 2 weeks of use. Dryness and peeling were seen with both treatments, but resolved by week 12. Stinging, tingling, itching, and burning also were common with both treatments, and largely resolved in both groups by week 8, except for significant stinging in the OTC treatment group. No significant overall differences were seen between the groups with respect to tolerance parameters, Ms. Raab noted.

“When compared, both treatments were at parity in improvement of all efficacy attributes at all time points,” she and her colleagues concluded.

Rosacea patients experience symptoms ranging from flushing to persistent acnelike rashes that can cause low self-esteem and anxiety, leading to social and professional isolation.¹ Although it is estimated that 16 million individuals in the United States have rosacea, only 10% seek treatment.^2,3 The motivation for patients to seek and adhere to treatment is not well characterized.

A patient journey is a map of the steps a patient takes as he/she progresses through different segments of the disease from diagnosis to management, including all the influences that can push him/her toward or away from certain decisions. The patient journey model provides a structure for understanding key issues in rosacea management, including barriers to successful treatment outcomes.

The patient journey model progresses from development of disease and diagnosis to treatment and disease management (Figure). We sought to examine each step of the rosacea patient journey to better understand key patient care boundaries faced by rosacea patients. We assessed the current literature regarding each step of the patient experience and identified areas of the patient journey with limited research.

Click here to view the figure as a PDF to print for future reference.

Researching the Patient Experience

A PubMed search of articles indexed for MEDLINE as well as a search of the National Rosacea Society Web site (http://www.rosacea.org) were conducted to identify articles and materials that quantitatively or qualitatively described rosacea patient experiences. Search terms included rosacea, rosacea patient experience, rosacea treatment, rosacea adherence, and rosacea quality of life. A Google search also was conducted using the same terms to obtain current news articles online. Current literature pertaining to the patient journey was summarized.

To create a model for the rosacea patient journey, we refined a rheumatoid arthritis patient journey map⁴ and included the critical components of the journey for rosacea patients. We organized the journey into stages, including prediagnosis, diagnosis, treatment, adherence, and management. We first explored what occurs prior to diagnosis, which includes the patient’s symptoms before visiting a physician. We then examined the process of diagnosis and the implementation of a treatment plan. Treatment adherence was then explored, ending with the ways patients self-manage their disease beyond the physician’s office.

Rosacea Patient Journey

Prediagnosis: What Motivates Patients to Seek Treatment

Rosacea can present with many symptoms that may lead patients to see a physician, including facial erythema and telangiectases, papules and pustules, phymatous changes, and ocular manifestations.⁵ The most common concern is temporary facial flushing, followed by persistent redness, then bumps and pimples.⁶ Many patients seek treatment after persistent facial flushing and an intolerable burning sensation. Some middle-aged patients decide to see a dermatologist for the first time when they break out in acne lesions after a history of clear skin. Others seek treatment because they can no longer tolerate the pain and embarrassment associated with their symptoms. However, patients who seek treatment only account for a small proportion of patients with rosacea, as only 10% of patients seek conventional medical treatment.⁷ Furthermore, symptomatic patients on average wait 7 months to 5 years before receiving a diagnosis.^8,9

Care often is delayed or not pursued because many rosacea symptoms are mild when they first appear and may not initially bother the patient. Patients may not think anything of their symptoms and dismiss them as either acne vulgaris or sunburn. Due to the relapsing and remitting nature of the disease course, patients may feel their symptoms will resolve. Of patients diagnosed with rosacea, only one-half have heard of the condition prior to diagnosis,⁸ which can largely be attributed to lack of patient education on the signs and symptoms of rosacea, a concern that prompted the National Rosacea Society to designate the month of April as rosacea awareness month.⁵

With sales of antiredness facial care products growing 35% from 2002 to 2007, accounting for an increase of $300 million in revenue, patients also may be turning to over-the-counter products first.¹⁰ Men with rosacea tend to present with more severe symptoms such as rhinophyma, which may be due to their desire to wait until their symptoms reached more advanced stages of disease before seeking medical help.⁵

Diagnosis of Rosacea

After the patient decides that his/her symptoms are unusual, severe, or intolerable enough to seek treatment, the issues of access to dermatologic care and receiving the correct diagnosis come into play. Accessing dermatologic care can be difficult, as appointments may be hard to obtain, and even if the patient is able to get an appointment, it could be many weeks later.¹¹ For some rosacea patients, the anxiety of waiting for their appointment prompts them to seek support and advice from online message boards (eg, http://www.rosacea-support.org). The long wait for appointments may be attributed to the increased demand for dermatologists for cosmetic procedures.¹² Additionally, disparities according to insurance type can contribute to difficulties procuring an appointment. In one study, privately insured dermatology patients demonstrated a 91% acceptance rate and shorter wait times for appointments compared to publicly insured patients who were limited to a 29.8% acceptance rate and longer wait times.¹¹ Many patients then are left to wait for an appointment with a dermatologist or instead turn to a primary care physician. Of patients diagnosed with rosacea in one study (N=2847), the majority of patients were seen by a dermatologist (79%), while the other patients were diagnosed by a family physician (14%) or other types of physicians such as internists and ophthalmologists (7%).⁶

The diagnosis of rosacea usually is not a major hurdle for dermatologists, but misdiagnoses can sometimes occur. The Rosacea Research & Development Institute compiled multiple patient anecdotes describing the struggles of finally reaching the correct diagnosis of rosacea; however, no estimates as to the frequency of misdiagnoses was estimated.¹³ Even with an accurate diagnosis of rosacea, correct classification of the 4 types of rosacea (ie, erythematotelangiectatic, papulopustular, phymatous, ocular) is necessary to avoid incorrect treatment recommendations. For example, patients with flushing often cannot tolerate topical medications in contrast to patients with the papulopustular subtype who benefit from them.¹⁴ In the meantime, the patients who are misdiagnosed may be met with frustration, as treatment was either delayed or incorrectly prescribed.

Although there are limited data regarding patient reactions after receiving a diagnosis of rosacea, it can be assumed that patients would be hopeful that diagnosis would lead to correct treatment. In a 2008 article in The New York Times, a rosacea patient was described as feeling relieved to be diagnosed with rosacea because it was an explanation for the development of pimples on the cheeks in her late 40s.¹⁰

Implementation of a Treatment Plan

After recognizing the symptoms and receiving a correct diagnosis, the next step in the patient journey is treatment. Long-term management of incurable conditions such as rosacea is difficult. The main goals of treatment are to relieve symptoms, improve appearance, delay progression to advanced stages, and maintain remission.¹⁵ There are only a few reliable clinical trials regarding therapies for rosacea, so treatment has mostly relied on clinical experience (Table). The efficacy and safety of many older treatments has not been assessed.¹⁵ Mainstays of treatment include both topical agents and oral medications. The use of topical metronidazole, oral tetracycline, and oral isotretinoin have been found to improve both skin lesions and quality of life.¹⁸ Initially, a combination of a topical and an oral medication may be used for at least the first 12 weeks, and improvement is usually gradual, taking many weeks to become evident.¹⁵ Long-term treatment with topical medications often is required for maintenance, which can last another 6 months or more.^19,20

Besides using pharmacologic therapies, some patients also may choose to undergo various procedures. The most common procedure is laser therapy, followed by dermabrasion, chemical peels, hot loop electrocoagulation, and surgical sculpting or plastic surgery.⁶ The use of these adjunct therapies may suggest impatience from the patient for improvement; it also indicates the lengths patients will go to and willingness to pay for improvement of symptoms.

Along with medication, patients are recommended to make changes to their skin care regimen and lifestyle. Rosacea patients typically have sensitive skin that may include symptoms such as dryness, scaling, stinging, burning, and pruritus.¹⁶ Skin care recommendations for rosacea patients include using a gentle cleanser and regularly applying sunscreen.⁵ Issues with physical appearance can be addressed with the use of cosmetic products such as green-tinted makeup to conceal skin lesions.²¹ Remission can be maintained by identifying certain triggers (eg, red wine, spicy foods, extreme temperatures, prolonged sun exposure, vigorous exercise) that can cause flare-ups.¹⁵ The most common trigger is sun exposure, making photoprotection an important component of the rosacea patient’s skin care regimen.⁶

Adherence

With a diagnosis and treatment plan in effect, the patient journey reaches the stage of treatment adherence, which should include ongoing education about the condition. Self-reported statistics from rosacea patients indicated that 28% of patients took time off from their treatment regimen,⁶ but actual nonadherence rates likely are higher. The most commonly reported reason for poor treatment adherence among rosacea patients was the impression that the symptoms had resolved or were adequately controlled.⁶ Treatment also must be affordable. In a national survey of rosacea patients, 24% of 427 patients receiving pharmacologic therapy planned on switching medications because of cost, and 17% of 769 patients discontinued medications due to co-pay/insurance issues.⁶ Other reasons cited for discontinuation of treatment included patient perception that symptoms were not that serious, co-pay/insurance issues, ineffectiveness of the medication, and side effects.⁶ Adherence to topical medications is lower than oral medications due to the time and inconvenience required for application.²² For some patients, topical medications may be too messy, have a strange odor, or stain clothing.

It is promising that most rosacea patients have reported the intent to continue using pharmacologic agents because the medication prevented worsening of their symptoms.⁶ However, there are still patients who switch or discontinue therapies without physician direction. These patients often cite that they desire more information at the time of diagnosis, particularly related to causes of flare-ups, physical symptoms to expect, drug treatment options, makeup to cover up visible symptoms, surgical or laser treatment options, psychological symptoms, patient support groups, and counseling options.⁶

Management

The last part of the journey is disease management, which occurs when the patient learns how to control his/her symptoms long-term. Important factors contributing to long-term control of rosacea flares are medication adherence and avoiding lifestyle triggers.^23,24 Through the other stages of the journey, the patient has learned which treatments work and which factors may lead to exacerbation of symptoms.

Educating Patients on the Journey

The patient journey is a concept that can be applied to any disease state and brings to light roadblocks that patients may face from the initial diagnosis to successful disease management. Rosacea patients are faced with confusing and aggravating symptoms that can cause anxiety and may lead them to seek treatment from a physician. Facial flushing and phymatous changes of the nose can be mistaken for alcohol abuse, leading rosacea to be a socially stigmatizing disease.¹⁵ Because rosacea involves mostly the facial skin, it can disrupt social and professional interactions, leading to quality-of-life effects such as difficulty functioning on a day-to-day basis, which can be detrimental because patients usually are aged 30 to 50 years and may be perceived based on their appearance in the workforce.³ A lack of confidence, low self-esteem, embarrassment, and anxiety can even lead to serious psychiatric conditions such as depression and body dysmorphic disorder.²⁵ Because the severity of rosacea increases over time, it is important to educate patients about seeking early treatment; therefore, understanding and awareness of rosacea symptoms are necessary to prompt patients to see a medical professional to either confirm or refute the diagnosis.

Rosacea is a clinical diagnosis that relies on patterns of primary and secondary features, as outlined in a 2002 report by the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea.⁵ Even with this consensus grading system, it appears that additional fine-tuning of the criteria is needed in the disease definition. Importantly, because much of the pathogenesis and progression of rosacea is still not completely understood, there is no laboratory benchmark test that can be utilized for correct diagnosis.¹⁴ Moreover, many of the clinical manifestations of rosacea are shared with other conditions, and patients may present with different symptoms or varying combinations.²⁶

Treatment of rosacea is multifactorial and behavioral, as patients must not only be able to obtain and adhere to oral and topical regimens and possible procedures but also avoid various lifestyle and environmental triggers and learn to cope with emotional distress caused by their symptoms. Although patients who discontinue use of medications appear to be in the minority, education is still needed to stress the chronic nature of rosacea and the importance of the continuation of treatment. Collaboration between the physician and patient is needed to determine why a certain medication may not be effective and explore other treatment options. Treatment ineffectiveness could be due to incorrect use of the product, failure to use an adjunct skin care regimen, or inability to control rosacea triggers. Adequate early follow-up also is needed to maximize patient adherence to treatment.²⁷ Working together with the patient to develop a treatment plan that can be followed is necessary for long-term control of rosacea symptoms.

There is little information on how to address the psychological needs of patients, but patients can find support from various avenues. For instance, the National Rosacea Society, a large advocacy group, produces newsletters and educational materials for both physicians and patients.^28,29 There also are online support groups for rosacea patients that have thousands of members who exchange stories and provide words of encouragement. Although there are not many face-to-face support groups, physicians may consider developing live support groups for their rosacea patients. As patients achieve the later stages of the rosacea patient journey, they hopefully will have controlled their symptoms by following a treatment regimen and learning to adapt to a new life of successful disease management.

Many aspects of the rosacea patient journey have yet to be explored. It is uncertain how long patients with symptoms of rosacea wait before seeking treatment, what methods they use to control their rosacea before they receive a prescribed treatment or physician recommendations, and how they react to their diagnosis. It also is unknown how many rosacea patients receive an initial misdiagnosis of another condition and which physicians typically make the misdiagnosis. We also need to know more about the role of psychological issues in addressing patient adherence to treatment. Similarly, what role do support groups such as online forums play on adherence? There is a need for more patient education and awareness of rosacea.

Conclusion

Patients may be relieved that rosacea is not a life-threatening condition, but they may be disappointed that there is no cure for rosacea. As the patient and dermatologist work together to find an appropriate treatment plan, identify certain triggers, and modify the skin care routine, the patient can become disciplined in controlling rosacea symptoms. Ultimately, with the alleviation of visible symptoms, the patient’s quality of life also can improve. Better understanding of the rosacea patient perspective can lead to a more efficient health care system, improved patient care, and better patient satisfaction.

Rosacea patients experience symptoms ranging from flushing to persistent acnelike rashes that can cause low self-esteem and anxiety, leading to social and professional isolation.¹ Although it is estimated that 16 million individuals in the United States have rosacea, only 10% seek treatment.^2,3 The motivation for patients to seek and adhere to treatment is not well characterized.

A patient journey is a map of the steps a patient takes as he/she progresses through different segments of the disease from diagnosis to management, including all the influences that can push him/her toward or away from certain decisions. The patient journey model provides a structure for understanding key issues in rosacea management, including barriers to successful treatment outcomes.

The patient journey model progresses from development of disease and diagnosis to treatment and disease management (Figure). We sought to examine each step of the rosacea patient journey to better understand key patient care boundaries faced by rosacea patients. We assessed the current literature regarding each step of the patient experience and identified areas of the patient journey with limited research.

Click here to view the figure as a PDF to print for future reference.

Researching the Patient Experience

A PubMed search of articles indexed for MEDLINE as well as a search of the National Rosacea Society Web site (http://www.rosacea.org) were conducted to identify articles and materials that quantitatively or qualitatively described rosacea patient experiences. Search terms included rosacea, rosacea patient experience, rosacea treatment, rosacea adherence, and rosacea quality of life. A Google search also was conducted using the same terms to obtain current news articles online. Current literature pertaining to the patient journey was summarized.

To create a model for the rosacea patient journey, we refined a rheumatoid arthritis patient journey map⁴ and included the critical components of the journey for rosacea patients. We organized the journey into stages, including prediagnosis, diagnosis, treatment, adherence, and management. We first explored what occurs prior to diagnosis, which includes the patient’s symptoms before visiting a physician. We then examined the process of diagnosis and the implementation of a treatment plan. Treatment adherence was then explored, ending with the ways patients self-manage their disease beyond the physician’s office.

Rosacea Patient Journey

Prediagnosis: What Motivates Patients to Seek Treatment

Rosacea can present with many symptoms that may lead patients to see a physician, including facial erythema and telangiectases, papules and pustules, phymatous changes, and ocular manifestations.⁵ The most common concern is temporary facial flushing, followed by persistent redness, then bumps and pimples.⁶ Many patients seek treatment after persistent facial flushing and an intolerable burning sensation. Some middle-aged patients decide to see a dermatologist for the first time when they break out in acne lesions after a history of clear skin. Others seek treatment because they can no longer tolerate the pain and embarrassment associated with their symptoms. However, patients who seek treatment only account for a small proportion of patients with rosacea, as only 10% of patients seek conventional medical treatment.⁷ Furthermore, symptomatic patients on average wait 7 months to 5 years before receiving a diagnosis.^8,9

Care often is delayed or not pursued because many rosacea symptoms are mild when they first appear and may not initially bother the patient. Patients may not think anything of their symptoms and dismiss them as either acne vulgaris or sunburn. Due to the relapsing and remitting nature of the disease course, patients may feel their symptoms will resolve. Of patients diagnosed with rosacea, only one-half have heard of the condition prior to diagnosis,⁸ which can largely be attributed to lack of patient education on the signs and symptoms of rosacea, a concern that prompted the National Rosacea Society to designate the month of April as rosacea awareness month.⁵

With sales of antiredness facial care products growing 35% from 2002 to 2007, accounting for an increase of $300 million in revenue, patients also may be turning to over-the-counter products first.¹⁰ Men with rosacea tend to present with more severe symptoms such as rhinophyma, which may be due to their desire to wait until their symptoms reached more advanced stages of disease before seeking medical help.⁵

Diagnosis of Rosacea

After the patient decides that his/her symptoms are unusual, severe, or intolerable enough to seek treatment, the issues of access to dermatologic care and receiving the correct diagnosis come into play. Accessing dermatologic care can be difficult, as appointments may be hard to obtain, and even if the patient is able to get an appointment, it could be many weeks later.¹¹ For some rosacea patients, the anxiety of waiting for their appointment prompts them to seek support and advice from online message boards (eg, http://www.rosacea-support.org). The long wait for appointments may be attributed to the increased demand for dermatologists for cosmetic procedures.¹² Additionally, disparities according to insurance type can contribute to difficulties procuring an appointment. In one study, privately insured dermatology patients demonstrated a 91% acceptance rate and shorter wait times for appointments compared to publicly insured patients who were limited to a 29.8% acceptance rate and longer wait times.¹¹ Many patients then are left to wait for an appointment with a dermatologist or instead turn to a primary care physician. Of patients diagnosed with rosacea in one study (N=2847), the majority of patients were seen by a dermatologist (79%), while the other patients were diagnosed by a family physician (14%) or other types of physicians such as internists and ophthalmologists (7%).⁶

The diagnosis of rosacea usually is not a major hurdle for dermatologists, but misdiagnoses can sometimes occur. The Rosacea Research & Development Institute compiled multiple patient anecdotes describing the struggles of finally reaching the correct diagnosis of rosacea; however, no estimates as to the frequency of misdiagnoses was estimated.¹³ Even with an accurate diagnosis of rosacea, correct classification of the 4 types of rosacea (ie, erythematotelangiectatic, papulopustular, phymatous, ocular) is necessary to avoid incorrect treatment recommendations. For example, patients with flushing often cannot tolerate topical medications in contrast to patients with the papulopustular subtype who benefit from them.¹⁴ In the meantime, the patients who are misdiagnosed may be met with frustration, as treatment was either delayed or incorrectly prescribed.

Although there are limited data regarding patient reactions after receiving a diagnosis of rosacea, it can be assumed that patients would be hopeful that diagnosis would lead to correct treatment. In a 2008 article in The New York Times, a rosacea patient was described as feeling relieved to be diagnosed with rosacea because it was an explanation for the development of pimples on the cheeks in her late 40s.¹⁰

Implementation of a Treatment Plan

After recognizing the symptoms and receiving a correct diagnosis, the next step in the patient journey is treatment. Long-term management of incurable conditions such as rosacea is difficult. The main goals of treatment are to relieve symptoms, improve appearance, delay progression to advanced stages, and maintain remission.¹⁵ There are only a few reliable clinical trials regarding therapies for rosacea, so treatment has mostly relied on clinical experience (Table). The efficacy and safety of many older treatments has not been assessed.¹⁵ Mainstays of treatment include both topical agents and oral medications. The use of topical metronidazole, oral tetracycline, and oral isotretinoin have been found to improve both skin lesions and quality of life.¹⁸ Initially, a combination of a topical and an oral medication may be used for at least the first 12 weeks, and improvement is usually gradual, taking many weeks to become evident.¹⁵ Long-term treatment with topical medications often is required for maintenance, which can last another 6 months or more.^19,20

Besides using pharmacologic therapies, some patients also may choose to undergo various procedures. The most common procedure is laser therapy, followed by dermabrasion, chemical peels, hot loop electrocoagulation, and surgical sculpting or plastic surgery.⁶ The use of these adjunct therapies may suggest impatience from the patient for improvement; it also indicates the lengths patients will go to and willingness to pay for improvement of symptoms.

Along with medication, patients are recommended to make changes to their skin care regimen and lifestyle. Rosacea patients typically have sensitive skin that may include symptoms such as dryness, scaling, stinging, burning, and pruritus.¹⁶ Skin care recommendations for rosacea patients include using a gentle cleanser and regularly applying sunscreen.⁵ Issues with physical appearance can be addressed with the use of cosmetic products such as green-tinted makeup to conceal skin lesions.²¹ Remission can be maintained by identifying certain triggers (eg, red wine, spicy foods, extreme temperatures, prolonged sun exposure, vigorous exercise) that can cause flare-ups.¹⁵ The most common trigger is sun exposure, making photoprotection an important component of the rosacea patient’s skin care regimen.⁶

Adherence

With a diagnosis and treatment plan in effect, the patient journey reaches the stage of treatment adherence, which should include ongoing education about the condition. Self-reported statistics from rosacea patients indicated that 28% of patients took time off from their treatment regimen,⁶ but actual nonadherence rates likely are higher. The most commonly reported reason for poor treatment adherence among rosacea patients was the impression that the symptoms had resolved or were adequately controlled.⁶ Treatment also must be affordable. In a national survey of rosacea patients, 24% of 427 patients receiving pharmacologic therapy planned on switching medications because of cost, and 17% of 769 patients discontinued medications due to co-pay/insurance issues.⁶ Other reasons cited for discontinuation of treatment included patient perception that symptoms were not that serious, co-pay/insurance issues, ineffectiveness of the medication, and side effects.⁶ Adherence to topical medications is lower than oral medications due to the time and inconvenience required for application.²² For some patients, topical medications may be too messy, have a strange odor, or stain clothing.

It is promising that most rosacea patients have reported the intent to continue using pharmacologic agents because the medication prevented worsening of their symptoms.⁶ However, there are still patients who switch or discontinue therapies without physician direction. These patients often cite that they desire more information at the time of diagnosis, particularly related to causes of flare-ups, physical symptoms to expect, drug treatment options, makeup to cover up visible symptoms, surgical or laser treatment options, psychological symptoms, patient support groups, and counseling options.⁶

Management

The last part of the journey is disease management, which occurs when the patient learns how to control his/her symptoms long-term. Important factors contributing to long-term control of rosacea flares are medication adherence and avoiding lifestyle triggers.^23,24 Through the other stages of the journey, the patient has learned which treatments work and which factors may lead to exacerbation of symptoms.

Educating Patients on the Journey

The patient journey is a concept that can be applied to any disease state and brings to light roadblocks that patients may face from the initial diagnosis to successful disease management. Rosacea patients are faced with confusing and aggravating symptoms that can cause anxiety and may lead them to seek treatment from a physician. Facial flushing and phymatous changes of the nose can be mistaken for alcohol abuse, leading rosacea to be a socially stigmatizing disease.¹⁵ Because rosacea involves mostly the facial skin, it can disrupt social and professional interactions, leading to quality-of-life effects such as difficulty functioning on a day-to-day basis, which can be detrimental because patients usually are aged 30 to 50 years and may be perceived based on their appearance in the workforce.³ A lack of confidence, low self-esteem, embarrassment, and anxiety can even lead to serious psychiatric conditions such as depression and body dysmorphic disorder.²⁵ Because the severity of rosacea increases over time, it is important to educate patients about seeking early treatment; therefore, understanding and awareness of rosacea symptoms are necessary to prompt patients to see a medical professional to either confirm or refute the diagnosis.

Rosacea is a clinical diagnosis that relies on patterns of primary and secondary features, as outlined in a 2002 report by the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea.⁵ Even with this consensus grading system, it appears that additional fine-tuning of the criteria is needed in the disease definition. Importantly, because much of the pathogenesis and progression of rosacea is still not completely understood, there is no laboratory benchmark test that can be utilized for correct diagnosis.¹⁴ Moreover, many of the clinical manifestations of rosacea are shared with other conditions, and patients may present with different symptoms or varying combinations.²⁶

Treatment of rosacea is multifactorial and behavioral, as patients must not only be able to obtain and adhere to oral and topical regimens and possible procedures but also avoid various lifestyle and environmental triggers and learn to cope with emotional distress caused by their symptoms. Although patients who discontinue use of medications appear to be in the minority, education is still needed to stress the chronic nature of rosacea and the importance of the continuation of treatment. Collaboration between the physician and patient is needed to determine why a certain medication may not be effective and explore other treatment options. Treatment ineffectiveness could be due to incorrect use of the product, failure to use an adjunct skin care regimen, or inability to control rosacea triggers. Adequate early follow-up also is needed to maximize patient adherence to treatment.²⁷ Working together with the patient to develop a treatment plan that can be followed is necessary for long-term control of rosacea symptoms.

There is little information on how to address the psychological needs of patients, but patients can find support from various avenues. For instance, the National Rosacea Society, a large advocacy group, produces newsletters and educational materials for both physicians and patients.^28,29 There also are online support groups for rosacea patients that have thousands of members who exchange stories and provide words of encouragement. Although there are not many face-to-face support groups, physicians may consider developing live support groups for their rosacea patients. As patients achieve the later stages of the rosacea patient journey, they hopefully will have controlled their symptoms by following a treatment regimen and learning to adapt to a new life of successful disease management.

Many aspects of the rosacea patient journey have yet to be explored. It is uncertain how long patients with symptoms of rosacea wait before seeking treatment, what methods they use to control their rosacea before they receive a prescribed treatment or physician recommendations, and how they react to their diagnosis. It also is unknown how many rosacea patients receive an initial misdiagnosis of another condition and which physicians typically make the misdiagnosis. We also need to know more about the role of psychological issues in addressing patient adherence to treatment. Similarly, what role do support groups such as online forums play on adherence? There is a need for more patient education and awareness of rosacea.

Conclusion

Patients may be relieved that rosacea is not a life-threatening condition, but they may be disappointed that there is no cure for rosacea. As the patient and dermatologist work together to find an appropriate treatment plan, identify certain triggers, and modify the skin care routine, the patient can become disciplined in controlling rosacea symptoms. Ultimately, with the alleviation of visible symptoms, the patient’s quality of life also can improve. Better understanding of the rosacea patient perspective can lead to a more efficient health care system, improved patient care, and better patient satisfaction.

Rosacea patients experience symptoms ranging from flushing to persistent acnelike rashes that can cause low self-esteem and anxiety, leading to social and professional isolation.¹ Although it is estimated that 16 million individuals in the United States have rosacea, only 10% seek treatment.^2,3 The motivation for patients to seek and adhere to treatment is not well characterized.

A patient journey is a map of the steps a patient takes as he/she progresses through different segments of the disease from diagnosis to management, including all the influences that can push him/her toward or away from certain decisions. The patient journey model provides a structure for understanding key issues in rosacea management, including barriers to successful treatment outcomes.

The patient journey model progresses from development of disease and diagnosis to treatment and disease management (Figure). We sought to examine each step of the rosacea patient journey to better understand key patient care boundaries faced by rosacea patients. We assessed the current literature regarding each step of the patient experience and identified areas of the patient journey with limited research.

Click here to view the figure as a PDF to print for future reference.

Researching the Patient Experience

A PubMed search of articles indexed for MEDLINE as well as a search of the National Rosacea Society Web site (http://www.rosacea.org) were conducted to identify articles and materials that quantitatively or qualitatively described rosacea patient experiences. Search terms included rosacea, rosacea patient experience, rosacea treatment, rosacea adherence, and rosacea quality of life. A Google search also was conducted using the same terms to obtain current news articles online. Current literature pertaining to the patient journey was summarized.

To create a model for the rosacea patient journey, we refined a rheumatoid arthritis patient journey map⁴ and included the critical components of the journey for rosacea patients. We organized the journey into stages, including prediagnosis, diagnosis, treatment, adherence, and management. We first explored what occurs prior to diagnosis, which includes the patient’s symptoms before visiting a physician. We then examined the process of diagnosis and the implementation of a treatment plan. Treatment adherence was then explored, ending with the ways patients self-manage their disease beyond the physician’s office.

Rosacea Patient Journey

Prediagnosis: What Motivates Patients to Seek Treatment

Rosacea can present with many symptoms that may lead patients to see a physician, including facial erythema and telangiectases, papules and pustules, phymatous changes, and ocular manifestations.⁵ The most common concern is temporary facial flushing, followed by persistent redness, then bumps and pimples.⁶ Many patients seek treatment after persistent facial flushing and an intolerable burning sensation. Some middle-aged patients decide to see a dermatologist for the first time when they break out in acne lesions after a history of clear skin. Others seek treatment because they can no longer tolerate the pain and embarrassment associated with their symptoms. However, patients who seek treatment only account for a small proportion of patients with rosacea, as only 10% of patients seek conventional medical treatment.⁷ Furthermore, symptomatic patients on average wait 7 months to 5 years before receiving a diagnosis.^8,9

Care often is delayed or not pursued because many rosacea symptoms are mild when they first appear and may not initially bother the patient. Patients may not think anything of their symptoms and dismiss them as either acne vulgaris or sunburn. Due to the relapsing and remitting nature of the disease course, patients may feel their symptoms will resolve. Of patients diagnosed with rosacea, only one-half have heard of the condition prior to diagnosis,⁸ which can largely be attributed to lack of patient education on the signs and symptoms of rosacea, a concern that prompted the National Rosacea Society to designate the month of April as rosacea awareness month.⁵

With sales of antiredness facial care products growing 35% from 2002 to 2007, accounting for an increase of $300 million in revenue, patients also may be turning to over-the-counter products first.¹⁰ Men with rosacea tend to present with more severe symptoms such as rhinophyma, which may be due to their desire to wait until their symptoms reached more advanced stages of disease before seeking medical help.⁵

Diagnosis of Rosacea

After the patient decides that his/her symptoms are unusual, severe, or intolerable enough to seek treatment, the issues of access to dermatologic care and receiving the correct diagnosis come into play. Accessing dermatologic care can be difficult, as appointments may be hard to obtain, and even if the patient is able to get an appointment, it could be many weeks later.¹¹ For some rosacea patients, the anxiety of waiting for their appointment prompts them to seek support and advice from online message boards (eg, http://www.rosacea-support.org). The long wait for appointments may be attributed to the increased demand for dermatologists for cosmetic procedures.¹² Additionally, disparities according to insurance type can contribute to difficulties procuring an appointment. In one study, privately insured dermatology patients demonstrated a 91% acceptance rate and shorter wait times for appointments compared to publicly insured patients who were limited to a 29.8% acceptance rate and longer wait times.¹¹ Many patients then are left to wait for an appointment with a dermatologist or instead turn to a primary care physician. Of patients diagnosed with rosacea in one study (N=2847), the majority of patients were seen by a dermatologist (79%), while the other patients were diagnosed by a family physician (14%) or other types of physicians such as internists and ophthalmologists (7%).⁶

The diagnosis of rosacea usually is not a major hurdle for dermatologists, but misdiagnoses can sometimes occur. The Rosacea Research & Development Institute compiled multiple patient anecdotes describing the struggles of finally reaching the correct diagnosis of rosacea; however, no estimates as to the frequency of misdiagnoses was estimated.¹³ Even with an accurate diagnosis of rosacea, correct classification of the 4 types of rosacea (ie, erythematotelangiectatic, papulopustular, phymatous, ocular) is necessary to avoid incorrect treatment recommendations. For example, patients with flushing often cannot tolerate topical medications in contrast to patients with the papulopustular subtype who benefit from them.¹⁴ In the meantime, the patients who are misdiagnosed may be met with frustration, as treatment was either delayed or incorrectly prescribed.

Although there are limited data regarding patient reactions after receiving a diagnosis of rosacea, it can be assumed that patients would be hopeful that diagnosis would lead to correct treatment. In a 2008 article in The New York Times, a rosacea patient was described as feeling relieved to be diagnosed with rosacea because it was an explanation for the development of pimples on the cheeks in her late 40s.¹⁰

Implementation of a Treatment Plan

After recognizing the symptoms and receiving a correct diagnosis, the next step in the patient journey is treatment. Long-term management of incurable conditions such as rosacea is difficult. The main goals of treatment are to relieve symptoms, improve appearance, delay progression to advanced stages, and maintain remission.¹⁵ There are only a few reliable clinical trials regarding therapies for rosacea, so treatment has mostly relied on clinical experience (Table). The efficacy and safety of many older treatments has not been assessed.¹⁵ Mainstays of treatment include both topical agents and oral medications. The use of topical metronidazole, oral tetracycline, and oral isotretinoin have been found to improve both skin lesions and quality of life.¹⁸ Initially, a combination of a topical and an oral medication may be used for at least the first 12 weeks, and improvement is usually gradual, taking many weeks to become evident.¹⁵ Long-term treatment with topical medications often is required for maintenance, which can last another 6 months or more.^19,20

Besides using pharmacologic therapies, some patients also may choose to undergo various procedures. The most common procedure is laser therapy, followed by dermabrasion, chemical peels, hot loop electrocoagulation, and surgical sculpting or plastic surgery.⁶ The use of these adjunct therapies may suggest impatience from the patient for improvement; it also indicates the lengths patients will go to and willingness to pay for improvement of symptoms.

Along with medication, patients are recommended to make changes to their skin care regimen and lifestyle. Rosacea patients typically have sensitive skin that may include symptoms such as dryness, scaling, stinging, burning, and pruritus.¹⁶ Skin care recommendations for rosacea patients include using a gentle cleanser and regularly applying sunscreen.⁵ Issues with physical appearance can be addressed with the use of cosmetic products such as green-tinted makeup to conceal skin lesions.²¹ Remission can be maintained by identifying certain triggers (eg, red wine, spicy foods, extreme temperatures, prolonged sun exposure, vigorous exercise) that can cause flare-ups.¹⁵ The most common trigger is sun exposure, making photoprotection an important component of the rosacea patient’s skin care regimen.⁶

Adherence

With a diagnosis and treatment plan in effect, the patient journey reaches the stage of treatment adherence, which should include ongoing education about the condition. Self-reported statistics from rosacea patients indicated that 28% of patients took time off from their treatment regimen,⁶ but actual nonadherence rates likely are higher. The most commonly reported reason for poor treatment adherence among rosacea patients was the impression that the symptoms had resolved or were adequately controlled.⁶ Treatment also must be affordable. In a national survey of rosacea patients, 24% of 427 patients receiving pharmacologic therapy planned on switching medications because of cost, and 17% of 769 patients discontinued medications due to co-pay/insurance issues.⁶ Other reasons cited for discontinuation of treatment included patient perception that symptoms were not that serious, co-pay/insurance issues, ineffectiveness of the medication, and side effects.⁶ Adherence to topical medications is lower than oral medications due to the time and inconvenience required for application.²² For some patients, topical medications may be too messy, have a strange odor, or stain clothing.

It is promising that most rosacea patients have reported the intent to continue using pharmacologic agents because the medication prevented worsening of their symptoms.⁶ However, there are still patients who switch or discontinue therapies without physician direction. These patients often cite that they desire more information at the time of diagnosis, particularly related to causes of flare-ups, physical symptoms to expect, drug treatment options, makeup to cover up visible symptoms, surgical or laser treatment options, psychological symptoms, patient support groups, and counseling options.⁶

Management

The last part of the journey is disease management, which occurs when the patient learns how to control his/her symptoms long-term. Important factors contributing to long-term control of rosacea flares are medication adherence and avoiding lifestyle triggers.^23,24 Through the other stages of the journey, the patient has learned which treatments work and which factors may lead to exacerbation of symptoms.

Educating Patients on the Journey

The patient journey is a concept that can be applied to any disease state and brings to light roadblocks that patients may face from the initial diagnosis to successful disease management. Rosacea patients are faced with confusing and aggravating symptoms that can cause anxiety and may lead them to seek treatment from a physician. Facial flushing and phymatous changes of the nose can be mistaken for alcohol abuse, leading rosacea to be a socially stigmatizing disease.¹⁵ Because rosacea involves mostly the facial skin, it can disrupt social and professional interactions, leading to quality-of-life effects such as difficulty functioning on a day-to-day basis, which can be detrimental because patients usually are aged 30 to 50 years and may be perceived based on their appearance in the workforce.³ A lack of confidence, low self-esteem, embarrassment, and anxiety can even lead to serious psychiatric conditions such as depression and body dysmorphic disorder.²⁵ Because the severity of rosacea increases over time, it is important to educate patients about seeking early treatment; therefore, understanding and awareness of rosacea symptoms are necessary to prompt patients to see a medical professional to either confirm or refute the diagnosis.

Rosacea is a clinical diagnosis that relies on patterns of primary and secondary features, as outlined in a 2002 report by the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea.⁵ Even with this consensus grading system, it appears that additional fine-tuning of the criteria is needed in the disease definition. Importantly, because much of the pathogenesis and progression of rosacea is still not completely understood, there is no laboratory benchmark test that can be utilized for correct diagnosis.¹⁴ Moreover, many of the clinical manifestations of rosacea are shared with other conditions, and patients may present with different symptoms or varying combinations.²⁶

Treatment of rosacea is multifactorial and behavioral, as patients must not only be able to obtain and adhere to oral and topical regimens and possible procedures but also avoid various lifestyle and environmental triggers and learn to cope with emotional distress caused by their symptoms. Although patients who discontinue use of medications appear to be in the minority, education is still needed to stress the chronic nature of rosacea and the importance of the continuation of treatment. Collaboration between the physician and patient is needed to determine why a certain medication may not be effective and explore other treatment options. Treatment ineffectiveness could be due to incorrect use of the product, failure to use an adjunct skin care regimen, or inability to control rosacea triggers. Adequate early follow-up also is needed to maximize patient adherence to treatment.²⁷ Working together with the patient to develop a treatment plan that can be followed is necessary for long-term control of rosacea symptoms.

There is little information on how to address the psychological needs of patients, but patients can find support from various avenues. For instance, the National Rosacea Society, a large advocacy group, produces newsletters and educational materials for both physicians and patients.^28,29 There also are online support groups for rosacea patients that have thousands of members who exchange stories and provide words of encouragement. Although there are not many face-to-face support groups, physicians may consider developing live support groups for their rosacea patients. As patients achieve the later stages of the rosacea patient journey, they hopefully will have controlled their symptoms by following a treatment regimen and learning to adapt to a new life of successful disease management.

Many aspects of the rosacea patient journey have yet to be explored. It is uncertain how long patients with symptoms of rosacea wait before seeking treatment, what methods they use to control their rosacea before they receive a prescribed treatment or physician recommendations, and how they react to their diagnosis. It also is unknown how many rosacea patients receive an initial misdiagnosis of another condition and which physicians typically make the misdiagnosis. We also need to know more about the role of psychological issues in addressing patient adherence to treatment. Similarly, what role do support groups such as online forums play on adherence? There is a need for more patient education and awareness of rosacea.

Conclusion

Patients may be relieved that rosacea is not a life-threatening condition, but they may be disappointed that there is no cure for rosacea. As the patient and dermatologist work together to find an appropriate treatment plan, identify certain triggers, and modify the skin care routine, the patient can become disciplined in controlling rosacea symptoms. Ultimately, with the alleviation of visible symptoms, the patient’s quality of life also can improve. Better understanding of the rosacea patient perspective can lead to a more efficient health care system, improved patient care, and better patient satisfaction.

The Food and Drug Administration has approved a topical formulation of ivermectin for the once-daily topical treatment of inflammatory lesions related to rosacea. The drug will be marketed as Soolantra by Galderma Laboratories.

Ivermectin 1% cream was found to be safe and effective for patients in with moderate to severe papulopustular rosacea in two identical phase III, multicenter, randomized, double-blind, 12-week, vehicle-controlled, parallel-group studies led by Dr. Linda Stein Gold, director of dermatology clinical research and a division head of dermatology at the Henry Ford Hospital in Detroit.

In both studies, a total of 910 patients were randomized 2:1 to receive ivermectin 1% cream or a control cream once daily. The two coprimary endpoints were the percentage of patients who achieved a “clear” or “almost clear” score on the Investigator’s Global Assessment (IGA) scale at week 12, and the change in inflammatory lesion counts from baseline to week 12. The secondary efficacy endpoint assessment was the percentage change in inflammatory lesion count from baseline to week 12. The researchers also assessed safety endpoints by examining adverse events.

The mean age of patients was 50 years, 96% were white, and 67% were women. Patients had about 30 lesions each; 76%-82% were classified as having moderate rosacea based on IGA score, and the rest had severe disease. More than 90% of patients in each arm completed the study through week 12.

At week 12 in both studies, a significantly higher percentage of patients in the treatment group achieved treatment success, compared with those in the control group (38%-40% vs. 12%-19%, respectively; P less than .001). That difference was seen as early as week 4. Fewer treatment-related adverse events were reported in the ivermectin group, compared with the control group (3.4% vs. 7.2%, respectively)

In a separate head-to-head study comparing ivermectin 1% cream with metronidazole 0.75% topical cream, investigators also found that the former was more effective at treating rosacea.

“Rosacea is a common and challenging condition to manage as it tends to vary from patient to patient, often requiring a tailored approach. For that reason, we are always looking for innovative new treatments,” Dr. Stein Gold said in a statement. “While some rosacea treatments for the common bumps and pimples of the condition may take more than 4 weeks to show effect, Soolantra Cream may provide initial results as early as week 2.”

Dr. Stein Gold is a consultant for Galderma.

[email protected]

Doug Brunk contributed to this report.

The Food and Drug Administration has approved a topical formulation of ivermectin for the once-daily topical treatment of inflammatory lesions related to rosacea. The drug will be marketed as Soolantra by Galderma Laboratories.

Ivermectin 1% cream was found to be safe and effective for patients in with moderate to severe papulopustular rosacea in two identical phase III, multicenter, randomized, double-blind, 12-week, vehicle-controlled, parallel-group studies led by Dr. Linda Stein Gold, director of dermatology clinical research and a division head of dermatology at the Henry Ford Hospital in Detroit.

In both studies, a total of 910 patients were randomized 2:1 to receive ivermectin 1% cream or a control cream once daily. The two coprimary endpoints were the percentage of patients who achieved a “clear” or “almost clear” score on the Investigator’s Global Assessment (IGA) scale at week 12, and the change in inflammatory lesion counts from baseline to week 12. The secondary efficacy endpoint assessment was the percentage change in inflammatory lesion count from baseline to week 12. The researchers also assessed safety endpoints by examining adverse events.

The mean age of patients was 50 years, 96% were white, and 67% were women. Patients had about 30 lesions each; 76%-82% were classified as having moderate rosacea based on IGA score, and the rest had severe disease. More than 90% of patients in each arm completed the study through week 12.

At week 12 in both studies, a significantly higher percentage of patients in the treatment group achieved treatment success, compared with those in the control group (38%-40% vs. 12%-19%, respectively; P less than .001). That difference was seen as early as week 4. Fewer treatment-related adverse events were reported in the ivermectin group, compared with the control group (3.4% vs. 7.2%, respectively)

In a separate head-to-head study comparing ivermectin 1% cream with metronidazole 0.75% topical cream, investigators also found that the former was more effective at treating rosacea.

“Rosacea is a common and challenging condition to manage as it tends to vary from patient to patient, often requiring a tailored approach. For that reason, we are always looking for innovative new treatments,” Dr. Stein Gold said in a statement. “While some rosacea treatments for the common bumps and pimples of the condition may take more than 4 weeks to show effect, Soolantra Cream may provide initial results as early as week 2.”

Dr. Stein Gold is a consultant for Galderma.

[email protected]

Doug Brunk contributed to this report.

The Food and Drug Administration has approved a topical formulation of ivermectin for the once-daily topical treatment of inflammatory lesions related to rosacea. The drug will be marketed as Soolantra by Galderma Laboratories.

Ivermectin 1% cream was found to be safe and effective for patients in with moderate to severe papulopustular rosacea in two identical phase III, multicenter, randomized, double-blind, 12-week, vehicle-controlled, parallel-group studies led by Dr. Linda Stein Gold, director of dermatology clinical research and a division head of dermatology at the Henry Ford Hospital in Detroit.

In both studies, a total of 910 patients were randomized 2:1 to receive ivermectin 1% cream or a control cream once daily. The two coprimary endpoints were the percentage of patients who achieved a “clear” or “almost clear” score on the Investigator’s Global Assessment (IGA) scale at week 12, and the change in inflammatory lesion counts from baseline to week 12. The secondary efficacy endpoint assessment was the percentage change in inflammatory lesion count from baseline to week 12. The researchers also assessed safety endpoints by examining adverse events.

The mean age of patients was 50 years, 96% were white, and 67% were women. Patients had about 30 lesions each; 76%-82% were classified as having moderate rosacea based on IGA score, and the rest had severe disease. More than 90% of patients in each arm completed the study through week 12.

At week 12 in both studies, a significantly higher percentage of patients in the treatment group achieved treatment success, compared with those in the control group (38%-40% vs. 12%-19%, respectively; P less than .001). That difference was seen as early as week 4. Fewer treatment-related adverse events were reported in the ivermectin group, compared with the control group (3.4% vs. 7.2%, respectively)

In a separate head-to-head study comparing ivermectin 1% cream with metronidazole 0.75% topical cream, investigators also found that the former was more effective at treating rosacea.

“Rosacea is a common and challenging condition to manage as it tends to vary from patient to patient, often requiring a tailored approach. For that reason, we are always looking for innovative new treatments,” Dr. Stein Gold said in a statement. “While some rosacea treatments for the common bumps and pimples of the condition may take more than 4 weeks to show effect, Soolantra Cream may provide initial results as early as week 2.”

Dr. Stein Gold is a consultant for Galderma.

[email protected]

Doug Brunk contributed to this report.

SAN DIEGO – An injectable collagen-based filler significantly outperformed saline placebo for treating acne scars, with durable effects at 12 months, according to a randomized, double-blind crossover trial of 147 adults.

The study “successfully demonstrates the effectiveness and safety of polymethylmethacrylate in atrophic acne scars,” said Dr. James Spencer, who conducted the research while at Mount Sinai School of Medicine in New York. Dr. Spencer is now in private practice in St. Petersburg, Fla.

Six months after treatment, 64% of patients who received the polymethylmethacrylate-collagen filler (or PMMA) had at least half their scars improve by at least 2 points on an acne rating scale, Dr. Spencer and his associates said at the annual meeting of the American Society for Dermatologic Surgery. Only 32% of the control group achieved that result (P = .0005). Response rates for the filler were 61% at 9 months and 70% at 12 months, and “crossover subjects subsequently treated with PMMA collagen showed similar response levels,” they said.

The PMMA-collagen filler is easy to administer; “works well on deep, severe scars; and should also work very well on shallow scars,” the researchers noted. The treatment “may enable practitioners to effectively treat acne scarring with no need for capital equipment expenditure or the risks associated with resurfacing procedures,” they said.

About 61% of patients in the study were female, participants averaged 44 years of age, and 20% were Fitzpatrick skin type V or VI. To enter the study, participants had to have at least four facial acne scars that were soft contoured, rolling, distensible, and rated moderate to severe (3-4) on a 4-point acne rating scale.

The patients were treated every 2 weeks for a month, and again at months 3 and 6. At 6 months, patients in the placebo group crossed over and received the filler, and all patients were followed for another 6 months.

Adverse effects were uncommon and included mild transient pain at the injection site, swelling, bruising, and acne, the researchers said. “There was no evidence of granulomas, changes in pigmentation, or hypertrophic scarring,” they added.

No funding source was reported for the study. Dr. Spencer and his coauthors reported financial relationships with Photomedex, Genentech, and Leo Pharma.

SAN DIEGO – An injectable collagen-based filler significantly outperformed saline placebo for treating acne scars, with durable effects at 12 months, according to a randomized, double-blind crossover trial of 147 adults.

The study “successfully demonstrates the effectiveness and safety of polymethylmethacrylate in atrophic acne scars,” said Dr. James Spencer, who conducted the research while at Mount Sinai School of Medicine in New York. Dr. Spencer is now in private practice in St. Petersburg, Fla.

Six months after treatment, 64% of patients who received the polymethylmethacrylate-collagen filler (or PMMA) had at least half their scars improve by at least 2 points on an acne rating scale, Dr. Spencer and his associates said at the annual meeting of the American Society for Dermatologic Surgery. Only 32% of the control group achieved that result (P = .0005). Response rates for the filler were 61% at 9 months and 70% at 12 months, and “crossover subjects subsequently treated with PMMA collagen showed similar response levels,” they said.

The PMMA-collagen filler is easy to administer; “works well on deep, severe scars; and should also work very well on shallow scars,” the researchers noted. The treatment “may enable practitioners to effectively treat acne scarring with no need for capital equipment expenditure or the risks associated with resurfacing procedures,” they said.

About 61% of patients in the study were female, participants averaged 44 years of age, and 20% were Fitzpatrick skin type V or VI. To enter the study, participants had to have at least four facial acne scars that were soft contoured, rolling, distensible, and rated moderate to severe (3-4) on a 4-point acne rating scale.

The patients were treated every 2 weeks for a month, and again at months 3 and 6. At 6 months, patients in the placebo group crossed over and received the filler, and all patients were followed for another 6 months.

Adverse effects were uncommon and included mild transient pain at the injection site, swelling, bruising, and acne, the researchers said. “There was no evidence of granulomas, changes in pigmentation, or hypertrophic scarring,” they added.

No funding source was reported for the study. Dr. Spencer and his coauthors reported financial relationships with Photomedex, Genentech, and Leo Pharma.

SAN DIEGO – An injectable collagen-based filler significantly outperformed saline placebo for treating acne scars, with durable effects at 12 months, according to a randomized, double-blind crossover trial of 147 adults.

The study “successfully demonstrates the effectiveness and safety of polymethylmethacrylate in atrophic acne scars,” said Dr. James Spencer, who conducted the research while at Mount Sinai School of Medicine in New York. Dr. Spencer is now in private practice in St. Petersburg, Fla.

Six months after treatment, 64% of patients who received the polymethylmethacrylate-collagen filler (or PMMA) had at least half their scars improve by at least 2 points on an acne rating scale, Dr. Spencer and his associates said at the annual meeting of the American Society for Dermatologic Surgery. Only 32% of the control group achieved that result (P = .0005). Response rates for the filler were 61% at 9 months and 70% at 12 months, and “crossover subjects subsequently treated with PMMA collagen showed similar response levels,” they said.

The PMMA-collagen filler is easy to administer; “works well on deep, severe scars; and should also work very well on shallow scars,” the researchers noted. The treatment “may enable practitioners to effectively treat acne scarring with no need for capital equipment expenditure or the risks associated with resurfacing procedures,” they said.

About 61% of patients in the study were female, participants averaged 44 years of age, and 20% were Fitzpatrick skin type V or VI. To enter the study, participants had to have at least four facial acne scars that were soft contoured, rolling, distensible, and rated moderate to severe (3-4) on a 4-point acne rating scale.

The patients were treated every 2 weeks for a month, and again at months 3 and 6. At 6 months, patients in the placebo group crossed over and received the filler, and all patients were followed for another 6 months.

Adverse effects were uncommon and included mild transient pain at the injection site, swelling, bruising, and acne, the researchers said. “There was no evidence of granulomas, changes in pigmentation, or hypertrophic scarring,” they added.

No funding source was reported for the study. Dr. Spencer and his coauthors reported financial relationships with Photomedex, Genentech, and Leo Pharma.