James Q. Del Rosso, DO: Important Things to Know About Rosacea

James Q. Del Rosso, DO, discussed the main takeaways from his presentation ‘What You Really Need to Know About Rosacea’ from the Fall Clinical Dermatology 2023 Conference for PAs & NPs.

Del Rosso serves both as a dermatologist and as the research director of JDR Dermatology Research in Las Vegas, Nevada.

“Obviously Rosacea is something that clinicians in dermatology see frequently, it's not too often that they have difficulty with the clinical diagnosis,” Del Rosso explained. “It's not something that you do a laboratory test, it's a clinical diagnosis. But you have to be aware of some of the important clinical features.”

Del Rosso added that things can be confusing due to the fact that rosacea can present in a variety of different ways, noting that the condition is not curable.

“It's important to look at the visible features, and direct your different therapies to what you're visibly seeing,” he said. “But sometimes there are so many things going on so it's hard to differentiate their faces…But if you don't know what the redness is related to, what redness is related to barrier impairment, what redness is related to flushing or vasodilation. Sometimes in the beginning, you just have to get the situation under control and let the patients know that, when things quiet down, you could start selecting some specific therapies to address the clinical features that are bothering them.”

He gave the example of therapies such as topical agents or oral agents that can be prescribed. Subantimicrobial-dose doxycycline is the only treatment approved for papules and pustules of rosacea, Del Rosso pointed out.

“But we have topical ivermectin, topical azelaic acid, and we have topical minocycline,” he said. “We have topical metronidazole and the newest and only formulation of benzoyl peroxide that I would recommend using is the one that's well studied and FDA-approved, which is an encapsulated benzoyl peroxide that works extremely well for papules and pustules.”

He noted that some patients believe benzoyl peroxide may be irritating, but he added that it is the only one proven to be effective and well tolerated.

“The background erythema that persists from dilated vessels is going to be something that needs alpha agonists like oxymetazoline or brimonidine, put on each day in the morning,” Del Rosso explained. “Patients will sometimes use it when they only want to get less red but really, if you really want to change the background redness over time, use it every day. And that will lessen that background erythema.”

He added that if patients have papules and pustules as well as background erythema, they need to utilize both of those therapies to take advantage of their benefits.

Later in the interview, Del Rosso described what he believes is one of the major contributors to rosacea patients not seeing the results they might like.

“The biggest problem with rosacea is the lack of follow through,” he stated. “And often the patients get frustrated and they disappear. Maybe sometimes they haven't been adequately educated. But if they follow through with the therapies we have, we can get many patients with rosacea significantly better in the short term and in the long term.”

For more on the contents of Del Rosso’s talk at the Clinical Dermatology conference, view the interview above.

The quotes contained here were edited for the purposes of clarity.