Journal of Dermatological Treatment, 2014; 25: 275–277 © 2014 Informa Healthcare USA on behalf of Informa UK Ltd. ISSN: 0954-6634 print / 1471-1753 online DOI: 10.3109/09546634.2013.851921
EDITORIAL
Patterns of ambulatory care usage and leading treatments for rosacea Scott A Davis1 & Steven R Feldman1,2,3 1
Departments of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, NC 27157-1071, USA, Departments of Pathology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, NC 27157-1071, USA and 3 Center for Dermatology Research, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157-1071, USA
J Dermatolog Treat Downloaded from informahealthcare.com by The University of Manchester on 10/15/14 For personal use only.
2
Abstract Background: Millions of rosacea sufferers are not being treated, and the reasons they do not get treatment are not well characterized. Objective: The aim of this study is to determine the main reasons for visit, providers seen and treatments used for rosacea. Methods: We used data from the National Ambulatory Medical Care Survey for 1993–2010, tabulating the leading reasons for visit, providers seen and treatments used in rosacea visits. Results:There were 1 750 000 visits per year for rosacea. The leading reasons for visit were other diseases of the skin (25.3%), skin rash (19.6%), and discoloration or abnormal pigmentation (14.7%). Dermatologists managed 72.4% of visits. The most common treatments used were topical metronidazole (29.3%), tetracycline (11.0%), minocycline (8.5%), doxycycline (7.9%), and oral metronidazole (6.9%). Limitations: Some reasons for visit were too nonspecific to provide good insight on why the patient made a visit. Conclusions: Dermatologists manage rosacea most commonly, but primary care physicians need the proper training to diagnose it correctly. Improved strategies to reach untreated people with rosacea are needed. Key words: erythema, redness, primary care, NAMCS, reason for visit, adherence
Introduction As many as 16 million Americans have rosacea, but less than 10% are being treated for the disease at any given time (1). Since facial redness carries social meaning, the triggers that motivate patients to seek care for rosacea may include incidents in which facial erythema is misinterpreted in social contexts by others who do not understand the disease process (2). Papules and pustules respond well to standard treatments, but only recently have treatments been developed that are highly effective in reducing redness (3,4). Frustration with treatments that do not relieve redness symptoms, as well as the intermittent, flaring nature of the disease in many patients, may contribute to poor adherence to rosacea treatment (5,6). The purpose of this study is to determine the main reasons for office visits in rosacea patients, as well as the providers seen and treatments used. Better understanding of the reasons rosacea patients visit physicians may strengthen efforts to reach out to patients not currently being treated.
Methods We analyzed nationally representative data from the National Ambulatory Medical Care Survey (NAMCS), collected annually by the National Center for Health Statistics (NCHS) to assess the provision of ambulatory patient care in the United States. Roughly 30 000 visits per year are selected by stratified random sampling, and are weighted to produce national estimates of the number of visits with particular characteristics. All outpatient visits to nonfederally-employed, office-based providers who provide direct patient care are eligible for sampling. Collected data include patient demographics, diagnoses, reasons for visit, treatments used and providers seen. In this study, visits in the 1993–2010 NAMCS with a diagnosis of rosacea (ICD-9-CM code 695.3) were selected and the number of rosacea visits to each specialty was recorded. The sole inclusion criterion was a diagnosis of rosacea according to the ICD-9-CM code. To describe the symptoms that caused patients eventually diagnosed with rosacea to come to the office, reason-for-visit codes linked to the selected visits were tabulated. The reason for visit is intended to record as accurately as possible the patient’s complaint in their own words, often symptoms rather than specific clinical diagnoses, and is not necessarily associated with a particular clinical diagnosis (ICD-9-CM code) used for billing. The reason-for-visit code is useful for identifying the symptoms or events that led the patient to make a visit. Unlike for the diagnosis, there is no specific reason-for-visit code defined as “rosacea”; rosacea is included in a category called “other diseases of the skin”. Other reason-for-visit codes identify frequently associated clinical symptoms, such as skin rash, or types of routine visit, such as general medical examination. To assess variation in patients’ experience with different physician specialties, leading reasons for visit in dermatology and primary care visits were tabulated. Leading treatments prescribed in each year were determined. Linear regression (SAS PROC SURVEYREG) was used to assess changes over time in the frequency with which specific rosacea treatments were used. All data analysis was performed using SAS 9.2 (SAS Institute, Cary, NC) and the study was declared exempt by the Wake Forest Baptist Hospital Institutional Review Board.
Results There were 1317 records weighted to produce the estimate of 31.5 million (95% CI: 29.3–33.7 million)
Correspondence: Scott A. Davis MA, Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA. Tel: +1 336 716 2702. Fax: +1 336 716 7732. E-mail: [email protected] (Accepted 2 October 2013)
S. A. Davis and S. R. Feldman Table I. Leading reasons for visit associated with a diagnosis of rosacea. Overall
Dermatologists
Reason for visit
Visits (%)
Other diseases of the skin* Skin rash Discoloration or abnormal pigmentation Acne or pimples General medical examination Skin lesion NOS Dryness/peeling/scaling/roughness of skin Progress visit NOS Symptoms of skin moles Other growths of skin
7 6 4 3 1 1 1 1 1 1
980 180 640 760 890 520 470 070 000 000
000 000 000 000 000 000 000 000 000 000
(25.3) (19.6) (14.7) (11.9) (6.0) (4.8) (4.7) (3.4) (3.2) (3.2)
Reason for visit
Visits (%)
Other diseases of the skin* Skin rash Discoloration or abnormal pigmentation Acne or pimples Dryness/peeling/scaling/roughness of skin Skin lesion NOS Other growths of skin Symptoms of skin moles Other special examination Progress visit NOS
7 4 4 3 1 1
070 220 210 300 420 350 990 990 880 760
000 000 000 000 000 000 000 000 000 000
(31.0) (18.5) (18.5) (14.5) (6.2) (5.9) (4.4) (4.3) (3.9) (3.3)
J Dermatolog Treat Downloaded from informahealthcare.com by The University of Manchester on 10/15/14 For personal use only.
*Includes rosacea. NOS: Not otherwise specified.
rosacea visits, or 1 750 000 per year. The leading reasons for visit included other diseases of the skin (25.3%), skin rash (19.6%), discoloration or abnormal pigmentation (14.7%), acne or pimples (11.9%) and general medical examination (6.0%; Table I). “Other diseases of the skin” includes rosacea, as there is no separate reason-for-visit code indicating rosacea. In dermatology visits, the leading reasons were other diseases of the skin (31.0%), skin rash (18.5%), discoloration or abnormal pigmentation (18.5%), acne or pimples (14.5%) and dryness/peeling/scaling/roughness of skin (6.2%). In primary care visits, the leading reason was skin rash (25.8%). Other reasons had too few visits for a statistically valid estimate, but included general medical examination, other diseases of the skin, acne or pimples, and medication (other and unspecified kinds). Thirty-one percent of patient visits among all specialties were classified as visits for a new problem. In these visits, the leading reasons for visit were skin rash (29.1%), discoloration or abnormal pigmentation (17.6%), other diseases of the skin (13.9%) and acne or pimples (12.1%). Rosacea visits were most commonly managed by dermatologists (72.4%), general and family practitioners (12.9%), internists (7.0%) and ophthalmologists (3.4%; Table II). On a per physician basis, dermatologists managed 159.8 visits annually per physician, or about 77 times more than primary care physicians, who managed 2.1 visits annually per physician. The leading treatments prescribed were topical metronidazole (29.3% of visits), tetracycline (11.0%), minocycline (8.5%), doxycycline (7.9%) and oral metronidazole (6.9%; Table III).
Discussion Rosacea is treated most often by dermatologists, but primary care physicians also have an important role to play. Primary care physicians typically observe rosacea in a general medical examination or in a visit with complaint of skin rash. By contrast, the leading reason for visit to dermatologists was “other diseases of the skin”, probably indicating rosacea had already been Table II. Leading physician specialties for rosacea visits. Specialty Dermatology General & family practice Internal medicine Ophthalmology All others
22 4 2 1 1
Visits (%) 810 000 (72.4) 060 000 (12.9) 210 000 (7.0) 060 000 (3.4) 380 000 (4.4)
Annual visits per physician in specialty 159.8 3.4 1.8 3.9 0.3
Annual visits per physician in specialty is based on the average number of physicians reported in each of the years 1993–2010.
diagnosed. Discoloration or abnormal pigmentation was also a common reason for visit to dermatologists, suggesting that patients are bothered by the erythema associated with rosacea. The leading treatments were all among those recognized as effective for rosacea, suggesting that rosacea is being treated appropriately once recognized (7,8). However, prescribing the right treatment does not guarantee successful outcomes; more studies are needed to determine why patients do not take their rosacea medications as directed (9). Based on the estimate of 16 million Americans having rosacea, the number of rosacea visits observed in our study indicates that at most 1 750 000, or 11%, of rosacea sufferers are receiving treatment in an average year. The percentage could even be considerably lower, to the extent that those patients who are getting treated are making multiple visits. Primary care physicians manage only about two visits per physician annually with a diagnosis of rosacea, which may increase the likelihood of misdiagnosis. They also may code a more generic diagnosis code, such as skin rash, or refer the patient without making a diagnosis. Primary care physicians should be encouraged to refer patients with possible rosacea symptoms to dermatologists if they are uncertain of the correct diagnosis. Limitations of the study include the lack of specificity in the reason-for-visit codes available in the NAMCS. The NAMCS also samples only single visits, so it is not possible to determine what sequence of providers or treatments were used over the course of multiple visits. The NAMCS also does not give specific clinical data that would indicate whether a provider failed to diagnose rosacea in a patient who had it. Patients who did not receive a diagnosis of rosacea could not be included in the dataset. Despite these limitations, the nationally representative sample improves confidence in the overall picture of rosacea treatment patterns presented here.
Table III. Leading treatments used in rosacea visits. Medication Metronidazole topical Tetracycline Minocycline Doxycycline Metronidazole oral Azelaic acid Desonide Ketoconazole Hydrocortisone Tretinoin
Visits (%) 9 3 2 2 2 1 1 1 1
230 470 690 480 180 480 170 040 030 780
000 000 000 000 000 000 000 000 000 000
(29.3) (11.0) (8.5) (7.9) (6.9) (4.7) (3.7) (3.3) (3.3) (2.5)
Patterns of ambulatory care usage and leading treatments for rosacea There are many opportunities to improve the care of rosacea sufferers. Improving awareness among both patients and primary care providers may increase the chance that people with rosacea will get the care they need. Since non-dermatologists tend to get very limited dermatology training, curricula should educate all physician trainees on recognizing rosacea (10). Understanding the typical patient experience with rosacea will then permit providers to design appropriate tools for ensuring good adherence to the therapies now available.
Capsule summary .
J Dermatolog Treat Downloaded from informahealthcare.com by The University of Manchester on 10/15/14 For personal use only.
.
.
Many rosacea sufferers are not receiving effective treatment. Leading reasons for visit were other diseases of the skin, skin rash, and abnormal pigmentation; dermatologists managed almost three-quarters of visits. Obstacles to effective rosacea treatment include lack of awareness, misdiagnosis and nonadherence.
Declaration of interest: The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P. Feldman is a consultant and speaker for Galderma, Stiefel/GlaxoSmithKline, Abbott Labs, Warner Chilcott, Janssen, Amgen, Photomedex, Genentech, BiogenIdec, and Bristol Myers Squibb. Feldman has received grants from Galderma, Astellas, Abbott Labs, Warner Chilcott, Janssen, Amgen, Photomedex, Genentech, BiogenIdec, Coria/ Valeant, Pharmaderm, Ortho Pharmaceuticals, Aventis Pharmaceuticals, Roche Dermatology, 3M, Bristol Myers Squibb, Stiefel/GlaxoSmithKline, Novartis, Medicis, Leo, HanAll Pharmaceuticals, Celgene, Basilea, and Anacor and has
received stock options from Photomedex. Feldman is the founder and holds stock in Causa Research. Davis has no conflicts to disclose.
References 1. National Rosacea Society. Rosacea now estimated to affect at least 16 million Americans. http://www rosacea org/rr/2010/winter/ article_1 php 2010.cited 27 Jun 2013. 2. Elewski BE, Draelos Z, Dreno B, Jansen T, Layton A, Picardo M. Rosacea - global diversity and optimized outcome: proposed international consensus from the Rosacea International Expert Group. J Eur Acad Dermatol Venereol. 2011;25:188–200. 3. Fowler J, Jarratt M, Moore A, Meadows K, Pollack A, Steinhoff M, et al. Once-daily topical brimonidine tartrate gel 0.5% is a novel treatment for moderate to severe facial erythema of rosacea: results of two multicentre, randomized and vehicle-controlled studies. Br J Dermatol. 2012;166:633–641. 4. Gupta AK, Chaudhry MM. Rosacea and its management: an overview. J Eur Acad Dermatol Venereol. 2005;19:273–285. 5. Elewski BE. Results of a national rosacea patient survey: common issues that concern rosacea sufferers. J Drugs Dermatol. 2009;8:120– 123. 6. Wolf JE Jr. Medication adherence: a key factor in effective management of rosacea. Adv Ther. 2001;18:272–281. 7. May D, Kelsberg G, Safranek S. Clinical inquiries. What is the most effective treatment for acne rosacea? J Fam Pract. 2011;60:108a–100c. 8. Del Rosso JQ, Baldwin H, Webster G. American Acne & Rosacea society rosacea medical management guidelines. J Drugs Dermatol. 2008;7:531–533. 9. Jayawant SS, Feldman SR, Camacho FT, Yentzer B, Balkrishnan R. Prescription refills and healthcare costs associated with topical metronidazole in Medicaid enrolled patients with rosacea. J Dermatolog Treat. 2008;19:267–273. 10. Ramsay DL, Fox AB. The ability of primary care physicians to recognize the common dermatoses. Arch Dermatol. 1981;117:620–622.
EDITORIAL
Patterns of ambulatory care usage and leading treatments for rosacea Scott A Davis1 & Steven R Feldman1,2,3 1
Departments of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, NC 27157-1071, USA, Departments of Pathology, Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, NC 27157-1071, USA and 3 Center for Dermatology Research, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157-1071, USA
J Dermatolog Treat Downloaded from informahealthcare.com by The University of Manchester on 10/15/14 For personal use only.
2
Abstract Background: Millions of rosacea sufferers are not being treated, and the reasons they do not get treatment are not well characterized. Objective: The aim of this study is to determine the main reasons for visit, providers seen and treatments used for rosacea. Methods: We used data from the National Ambulatory Medical Care Survey for 1993–2010, tabulating the leading reasons for visit, providers seen and treatments used in rosacea visits. Results:There were 1 750 000 visits per year for rosacea. The leading reasons for visit were other diseases of the skin (25.3%), skin rash (19.6%), and discoloration or abnormal pigmentation (14.7%). Dermatologists managed 72.4% of visits. The most common treatments used were topical metronidazole (29.3%), tetracycline (11.0%), minocycline (8.5%), doxycycline (7.9%), and oral metronidazole (6.9%). Limitations: Some reasons for visit were too nonspecific to provide good insight on why the patient made a visit. Conclusions: Dermatologists manage rosacea most commonly, but primary care physicians need the proper training to diagnose it correctly. Improved strategies to reach untreated people with rosacea are needed. Key words: erythema, redness, primary care, NAMCS, reason for visit, adherence
Introduction As many as 16 million Americans have rosacea, but less than 10% are being treated for the disease at any given time (1). Since facial redness carries social meaning, the triggers that motivate patients to seek care for rosacea may include incidents in which facial erythema is misinterpreted in social contexts by others who do not understand the disease process (2). Papules and pustules respond well to standard treatments, but only recently have treatments been developed that are highly effective in reducing redness (3,4). Frustration with treatments that do not relieve redness symptoms, as well as the intermittent, flaring nature of the disease in many patients, may contribute to poor adherence to rosacea treatment (5,6). The purpose of this study is to determine the main reasons for office visits in rosacea patients, as well as the providers seen and treatments used. Better understanding of the reasons rosacea patients visit physicians may strengthen efforts to reach out to patients not currently being treated.
Methods We analyzed nationally representative data from the National Ambulatory Medical Care Survey (NAMCS), collected annually by the National Center for Health Statistics (NCHS) to assess the provision of ambulatory patient care in the United States. Roughly 30 000 visits per year are selected by stratified random sampling, and are weighted to produce national estimates of the number of visits with particular characteristics. All outpatient visits to nonfederally-employed, office-based providers who provide direct patient care are eligible for sampling. Collected data include patient demographics, diagnoses, reasons for visit, treatments used and providers seen. In this study, visits in the 1993–2010 NAMCS with a diagnosis of rosacea (ICD-9-CM code 695.3) were selected and the number of rosacea visits to each specialty was recorded. The sole inclusion criterion was a diagnosis of rosacea according to the ICD-9-CM code. To describe the symptoms that caused patients eventually diagnosed with rosacea to come to the office, reason-for-visit codes linked to the selected visits were tabulated. The reason for visit is intended to record as accurately as possible the patient’s complaint in their own words, often symptoms rather than specific clinical diagnoses, and is not necessarily associated with a particular clinical diagnosis (ICD-9-CM code) used for billing. The reason-for-visit code is useful for identifying the symptoms or events that led the patient to make a visit. Unlike for the diagnosis, there is no specific reason-for-visit code defined as “rosacea”; rosacea is included in a category called “other diseases of the skin”. Other reason-for-visit codes identify frequently associated clinical symptoms, such as skin rash, or types of routine visit, such as general medical examination. To assess variation in patients’ experience with different physician specialties, leading reasons for visit in dermatology and primary care visits were tabulated. Leading treatments prescribed in each year were determined. Linear regression (SAS PROC SURVEYREG) was used to assess changes over time in the frequency with which specific rosacea treatments were used. All data analysis was performed using SAS 9.2 (SAS Institute, Cary, NC) and the study was declared exempt by the Wake Forest Baptist Hospital Institutional Review Board.
Results There were 1317 records weighted to produce the estimate of 31.5 million (95% CI: 29.3–33.7 million)
Correspondence: Scott A. Davis MA, Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA. Tel: +1 336 716 2702. Fax: +1 336 716 7732. E-mail: [email protected] (Accepted 2 October 2013)
S. A. Davis and S. R. Feldman Table I. Leading reasons for visit associated with a diagnosis of rosacea. Overall
Dermatologists
Reason for visit
Visits (%)
Other diseases of the skin* Skin rash Discoloration or abnormal pigmentation Acne or pimples General medical examination Skin lesion NOS Dryness/peeling/scaling/roughness of skin Progress visit NOS Symptoms of skin moles Other growths of skin
7 6 4 3 1 1 1 1 1 1
980 180 640 760 890 520 470 070 000 000
000 000 000 000 000 000 000 000 000 000
(25.3) (19.6) (14.7) (11.9) (6.0) (4.8) (4.7) (3.4) (3.2) (3.2)
Reason for visit
Visits (%)
Other diseases of the skin* Skin rash Discoloration or abnormal pigmentation Acne or pimples Dryness/peeling/scaling/roughness of skin Skin lesion NOS Other growths of skin Symptoms of skin moles Other special examination Progress visit NOS
7 4 4 3 1 1
070 220 210 300 420 350 990 990 880 760
000 000 000 000 000 000 000 000 000 000
(31.0) (18.5) (18.5) (14.5) (6.2) (5.9) (4.4) (4.3) (3.9) (3.3)
J Dermatolog Treat Downloaded from informahealthcare.com by The University of Manchester on 10/15/14 For personal use only.
*Includes rosacea. NOS: Not otherwise specified.
rosacea visits, or 1 750 000 per year. The leading reasons for visit included other diseases of the skin (25.3%), skin rash (19.6%), discoloration or abnormal pigmentation (14.7%), acne or pimples (11.9%) and general medical examination (6.0%; Table I). “Other diseases of the skin” includes rosacea, as there is no separate reason-for-visit code indicating rosacea. In dermatology visits, the leading reasons were other diseases of the skin (31.0%), skin rash (18.5%), discoloration or abnormal pigmentation (18.5%), acne or pimples (14.5%) and dryness/peeling/scaling/roughness of skin (6.2%). In primary care visits, the leading reason was skin rash (25.8%). Other reasons had too few visits for a statistically valid estimate, but included general medical examination, other diseases of the skin, acne or pimples, and medication (other and unspecified kinds). Thirty-one percent of patient visits among all specialties were classified as visits for a new problem. In these visits, the leading reasons for visit were skin rash (29.1%), discoloration or abnormal pigmentation (17.6%), other diseases of the skin (13.9%) and acne or pimples (12.1%). Rosacea visits were most commonly managed by dermatologists (72.4%), general and family practitioners (12.9%), internists (7.0%) and ophthalmologists (3.4%; Table II). On a per physician basis, dermatologists managed 159.8 visits annually per physician, or about 77 times more than primary care physicians, who managed 2.1 visits annually per physician. The leading treatments prescribed were topical metronidazole (29.3% of visits), tetracycline (11.0%), minocycline (8.5%), doxycycline (7.9%) and oral metronidazole (6.9%; Table III).
Discussion Rosacea is treated most often by dermatologists, but primary care physicians also have an important role to play. Primary care physicians typically observe rosacea in a general medical examination or in a visit with complaint of skin rash. By contrast, the leading reason for visit to dermatologists was “other diseases of the skin”, probably indicating rosacea had already been Table II. Leading physician specialties for rosacea visits. Specialty Dermatology General & family practice Internal medicine Ophthalmology All others
22 4 2 1 1
Visits (%) 810 000 (72.4) 060 000 (12.9) 210 000 (7.0) 060 000 (3.4) 380 000 (4.4)
Annual visits per physician in specialty 159.8 3.4 1.8 3.9 0.3
Annual visits per physician in specialty is based on the average number of physicians reported in each of the years 1993–2010.
diagnosed. Discoloration or abnormal pigmentation was also a common reason for visit to dermatologists, suggesting that patients are bothered by the erythema associated with rosacea. The leading treatments were all among those recognized as effective for rosacea, suggesting that rosacea is being treated appropriately once recognized (7,8). However, prescribing the right treatment does not guarantee successful outcomes; more studies are needed to determine why patients do not take their rosacea medications as directed (9). Based on the estimate of 16 million Americans having rosacea, the number of rosacea visits observed in our study indicates that at most 1 750 000, or 11%, of rosacea sufferers are receiving treatment in an average year. The percentage could even be considerably lower, to the extent that those patients who are getting treated are making multiple visits. Primary care physicians manage only about two visits per physician annually with a diagnosis of rosacea, which may increase the likelihood of misdiagnosis. They also may code a more generic diagnosis code, such as skin rash, or refer the patient without making a diagnosis. Primary care physicians should be encouraged to refer patients with possible rosacea symptoms to dermatologists if they are uncertain of the correct diagnosis. Limitations of the study include the lack of specificity in the reason-for-visit codes available in the NAMCS. The NAMCS also samples only single visits, so it is not possible to determine what sequence of providers or treatments were used over the course of multiple visits. The NAMCS also does not give specific clinical data that would indicate whether a provider failed to diagnose rosacea in a patient who had it. Patients who did not receive a diagnosis of rosacea could not be included in the dataset. Despite these limitations, the nationally representative sample improves confidence in the overall picture of rosacea treatment patterns presented here.
Table III. Leading treatments used in rosacea visits. Medication Metronidazole topical Tetracycline Minocycline Doxycycline Metronidazole oral Azelaic acid Desonide Ketoconazole Hydrocortisone Tretinoin
Visits (%) 9 3 2 2 2 1 1 1 1
230 470 690 480 180 480 170 040 030 780
000 000 000 000 000 000 000 000 000 000
(29.3) (11.0) (8.5) (7.9) (6.9) (4.7) (3.7) (3.3) (3.3) (2.5)
Patterns of ambulatory care usage and leading treatments for rosacea There are many opportunities to improve the care of rosacea sufferers. Improving awareness among both patients and primary care providers may increase the chance that people with rosacea will get the care they need. Since non-dermatologists tend to get very limited dermatology training, curricula should educate all physician trainees on recognizing rosacea (10). Understanding the typical patient experience with rosacea will then permit providers to design appropriate tools for ensuring good adherence to the therapies now available.
Capsule summary .
J Dermatolog Treat Downloaded from informahealthcare.com by The University of Manchester on 10/15/14 For personal use only.
.
.
Many rosacea sufferers are not receiving effective treatment. Leading reasons for visit were other diseases of the skin, skin rash, and abnormal pigmentation; dermatologists managed almost three-quarters of visits. Obstacles to effective rosacea treatment include lack of awareness, misdiagnosis and nonadherence.
Declaration of interest: The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P. Feldman is a consultant and speaker for Galderma, Stiefel/GlaxoSmithKline, Abbott Labs, Warner Chilcott, Janssen, Amgen, Photomedex, Genentech, BiogenIdec, and Bristol Myers Squibb. Feldman has received grants from Galderma, Astellas, Abbott Labs, Warner Chilcott, Janssen, Amgen, Photomedex, Genentech, BiogenIdec, Coria/ Valeant, Pharmaderm, Ortho Pharmaceuticals, Aventis Pharmaceuticals, Roche Dermatology, 3M, Bristol Myers Squibb, Stiefel/GlaxoSmithKline, Novartis, Medicis, Leo, HanAll Pharmaceuticals, Celgene, Basilea, and Anacor and has
received stock options from Photomedex. Feldman is the founder and holds stock in Causa Research. Davis has no conflicts to disclose.
References 1. National Rosacea Society. Rosacea now estimated to affect at least 16 million Americans. http://www rosacea org/rr/2010/winter/ article_1 php 2010.cited 27 Jun 2013. 2. Elewski BE, Draelos Z, Dreno B, Jansen T, Layton A, Picardo M. Rosacea - global diversity and optimized outcome: proposed international consensus from the Rosacea International Expert Group. J Eur Acad Dermatol Venereol. 2011;25:188–200. 3. Fowler J, Jarratt M, Moore A, Meadows K, Pollack A, Steinhoff M, et al. Once-daily topical brimonidine tartrate gel 0.5% is a novel treatment for moderate to severe facial erythema of rosacea: results of two multicentre, randomized and vehicle-controlled studies. Br J Dermatol. 2012;166:633–641. 4. Gupta AK, Chaudhry MM. Rosacea and its management: an overview. J Eur Acad Dermatol Venereol. 2005;19:273–285. 5. Elewski BE. Results of a national rosacea patient survey: common issues that concern rosacea sufferers. J Drugs Dermatol. 2009;8:120– 123. 6. Wolf JE Jr. Medication adherence: a key factor in effective management of rosacea. Adv Ther. 2001;18:272–281. 7. May D, Kelsberg G, Safranek S. Clinical inquiries. What is the most effective treatment for acne rosacea? J Fam Pract. 2011;60:108a–100c. 8. Del Rosso JQ, Baldwin H, Webster G. American Acne & Rosacea society rosacea medical management guidelines. J Drugs Dermatol. 2008;7:531–533. 9. Jayawant SS, Feldman SR, Camacho FT, Yentzer B, Balkrishnan R. Prescription refills and healthcare costs associated with topical metronidazole in Medicaid enrolled patients with rosacea. J Dermatolog Treat. 2008;19:267–273. 10. Ramsay DL, Fox AB. The ability of primary care physicians to recognize the common dermatoses. Arch Dermatol. 1981;117:620–622.
