Associations With Comorbidities
The past year has seen multiple studies link rosacea with additional comorbidities. Most recently, researchers in Turkey found a connection between patients with rosacea and increased risk of anxiety disorders.8 In this study, 194 patients with rosacea and 194 age- and sex-matched controls were evaluated by the Generalized Anxiety Disorder 7-item scale and the Generalized Anxiety Disorder Severity Scale to determine relation between rosacea and anxiety. Overall, the study found various risk factors for anxiety in patients with rosacea, including:
- Phymatous rosacea (P<.05);
- Female gender (P<.05);
- Prior history of psychiatric morbidity (P<.05);
- Self-reported rosacea flare-up with stress (P<.001);
- Low educational level (P<.05); and
- Condition left untreated (P=.04).
Previous research has linked rosacea with an increased risk of certain cancers.9-11 A study conducted in China that compared 7548 patients with confirmed malignancy and 8340 cancer-free controls explored other possible associations between rosacea and cancer.12 This study did find that 98.95% of the 190 female patients with breast cancer also had erythematotelangiectatic rosacea.
Withal, these results are based solely on relative association.13 As Tjahjono et al13 discuss, physicians should be careful and transparent in their discussions of risks with patients regarding rosacea. For example, relative risk for thyroid cancer is 1.60 and the attributable risk is 1.41; yet, the number of patients that need to be seen in 1 year to attribute one case of thyroid cancer to rosacea is 7080. Therefore, using absolute terms instead of relative ones are critical to understanding rosacea’s overall impact.13
The Product Pipeline
Upcoming products offer new possibilities to mitigating the symptoms of rosacea. Among those new treatments is FMX103, a 1.5% minocycline foam for the treatment of moderate to severe papulopustular rosacea. Two phase 3, randomized, multicenter, double-blind, vehicle-controlled studies sought to determine if FMX103 is an effective and safe option for patients.14 Between the studies, 1522 patients were randomized 2:1 to either the FMX103 group or the vehicle group and used either FMX103 or vehicle once daily to the face for 12 weeks.
At baseline, patients had mean inflammatory lesion counts of 28.5 and 30.0 in the FMX103 treatment group vs 29.0 and 30.2 for the vehicle. After 12 weeks of treatment, the FMX103 group demonstrated significant reductions in the mean inflammatory lesion count from baseline vs vehicle (FX2016-11, −17.57 vs −15.65, P=.003; FX2016-12, −18.54 vs −14.88, P<.0001).
Since the clinical studies, a New Drug Application for FMX103 has been approved by the FDA, with June 2, 2020, set as the Prescription Drug User Fee Act action date.15
Moisturization and sun protection are essential steps to skin care with rosacea, and one upcoming product hopes to fulfill both these needs. A tinted daily SPF-30 facial moisturizer (DFM30) was tested on patients with mild to moderate rosacea and nontransient erytema to assess its efficacy, tolerability, and ability to improve dry skin barrier function on rosacea-prone skin.16 After the initial application of DFM30 on day 1, 33.3% of patients showed improved covering of skin redness improved. After 22 days of use, image analysis suggested redness was significantly lower than at baseline, and chromameter readings on the cheeks showed significantly lower erythema.
In addition, patients who reported feeling DFM30 relieved and neutralized visible redness also stated they would purchase the product. Overall, DFM30 was well-tolerated and could improve cutaneous barrier function and the appearance of rosacea.
1. Tan J, Steinhoff M, Bewley A, Gieler U. Rosacea: Beyond the visible report. British Medical Journal. https://hosted.bmj.com/media/images/burden-of-rosacea-beyond-the-visible.pdf. June 2018. Accessed November 26, 2019.
2. Tan J, Steinhoff M, Bewley A, Gieler U, Rivers V. Identifying high-burden patients with rosacea by demographic and disease-related factors. Presented at: American Academy of Dermatology Annual Meeting; March 1-5, 2019; Washington, DC.
3. Terhaar E. New rosacea survey shows positive impact of clear skin. National Rosacea Society. https://www.rosacea.org/blog/2019/june/new-rosacea-survey-shows-positive-impact-clear-skin. June 3, 2019. Accessed November 26, 2019.
4. Al Abadie M, Asharaff F, Al Abadie D. Psychosocial impact of rosacea on women. J Dermatol Res Ther. 2019;5(2). doi:10.23937/2469-5750/1510074
5. Alexis AF, Callender VD, Baldwin HE, Deai SR, Rendon MI, Taylor SC. Global epidemiology and clinical spectrum of rosacea, highlighting skin of color: review and clinical practice experience. J Am Acad Dermatol. 2019;80(6):1722-1729.e7. doi:10.1016/j.jaad.2018.08.049
6. Tan J, Blume-Peytavi U, Ortonne JP, et al. An observational cross-sectional survey of rosacea: clinical associations and progression between subtypes. Br J Dermatol. 2013;163(3):555-562. doi:10.1111/bjd.12385
7. Kundu RV, Patterson S. Dermatologic conditions in skin of color: part I. Special consideration for common skin disorders. Am Fam Physician. 2013;87(12):850-856.
8. Uysal PI, Akdogan N, Hayran Y, Oktem A, Yalcin B. Rosacea associated with increased risk of generalized anxiety disorder: a case-control study of prevalence and risk of anxiety in patients with rosacea [published online October 30, 2019]. Ann Bras Dermatol. doi:10.1016/j.abd.2019.03.002
9. Li WQ, Zhang M, Danby FW, Han J, Quershi AA. Personal history of rosacea and risk of incident cancer among women in the US. Br J Cancer. 2015;113(3):520-523. doi:10.1038/bjc.2015.217
10. Egeberg A, Hansen PR, Gislason GH, Thyssen JP. Association of rosacea with risk for glioma in a Danish nationwide cohort study. JAMA Dermatol. 2016;152(5):541-545. doi:10.1001/jamadermatol.2015.5549
11. Egeberg A, Fowler JF Jr, Gislason GH, Thyssen JP. Rosacea and risk of cancer in Denmark. Cancer Epidemiol. 2017;47:76-80. doi:10.1016/j.canep.2017.01.006
12. Long J, Li J, Yuan X, et al. Potential association between rosacea and cancer: a study in a medical center in southern China. J Dermatol. 2019;46(7):570-576. doi:10.1111/1346-8138.14918
13. Tjahjono LA, Cline A, Huang WW, Fleischer AB Jr, Feldman SR. Rosacea: relative risk versus absolute risk of malignant comorbidities. J Am Acad Dermatol. 2019;81(2):623-624. doi:10.1016/j.jaad.2019.01.013
14. Gold LS, Del Rosso JQ, Bhatia ND, Hooper D, Nahm W, Stuart I. Efficacy and safety of FMX103 (1.5% minocycline foam) in the treatment of moderate-to-severe papulopustular rosacea: results from two phase 3 randomized, multicenter, double-blind, vehicle-controlled studies. Poster presented at: SDPA Annual Fall Dermatology Conference; November 21-24, 2019; Scottsdale, AZ.
15. Foamix announces FDA acceptance of its new drug application for FMX103 minocycline foam for the treatment of moderate-to-severe papulopustular rosacea [press release]. Bridgewater, NJ; October 17, 2019. https://www.foamix.com/news-releases/news-release-details/foamix-announces-fda-acceptance-its-new-drug-application-fmx103. Accessed November 27, 2019.
16. Baldwin H, Santoro F, Lachmann N, Teissedre S. A novel moisturizer with high sun protection factor improves cutaneous barrier function and the visible appearance of rosacea-prone skin [published online February 25, 2019]. J Cosmetic Dermatol. doi:10.1111/jocd.12889