Julie C. Harper, MD, Answers Rosacea Treatment Questions

Dr Harper

Dr Harper answers top questions about how she approaches rosacea treatment.

Julie C. Harper, MD, who is a clinical associate professor of dermatology at the University of Alabama-Birmingham, has been in private practice at The Dermatology and Skin Care Center of Birmingham in Alabama since 2007. She is a member of the National Rosacea Society (NRS) Medical Advisory Board and is the founding director and president of the American Acne and Rosacea Society. Dr Harper has written and presented on the topic of acne and rosacea extensively.

In a Q&A with The Dermatologist, Dr Harper discussed various topics including how the new standard classification and pathophysiology of rosacea published in the Journal of the American Academy of Dermatology1 is impacting her patients with rosacea and advances in the field of rosacea, and shared advice for fellow dermatologists treating this patient population.

Q. Why did you choose dermatology as your specialty? 

A. I chose dermatology as a specialty because I suffered with acne during my adolescent years. My dermatologist had a positive impact on my life by effectively treating my acne. I still love to treat acne because I know firsthand how much it can change a life.

Q. How is the recently updated Rosacea Standard Classification and Pathophysiology system impacting the treatment of your patients with rosacea? 

A. Rosacea can present in our clinics in a variety of ways. Some patients have just persistent facial erythema, while other patients seem to exhibit every rosacea phenotype at one time. This new classification reminds us to recognize and treat the phenotypes that we see even when 3 or 4 overlap in one patient. Instead of trying to pick one subtype to label our rosacea patients, we now observe and document and treat all of the phenotypic lesions that they have. 

Q. What rosacea advances are you most excited about?

A. We continue to learn about the pathogenesis of rosacea. In particular, I am interested in what we are learning about the neurovascular/neuroinflammatory pathways in rosacea. The current medications that we have for rosacea may not impact these pathways in particular. Case in point, we can use medications that greatly decrease inflammatory papules and pustules and yet, background redness may not change a lot.   

Q. What are some areas or therapies that are most promising for your patients with rosacea?

A. The best way to make our patients better is to treat all of the phenotypes that we observe in one patient. Combinations of therapies (ie, oral and/or topical medications that address papules and pustules, vasoconstrictors that address background erythema, and lasers that address telangiectases) offer our patients the potential for the best outcomes.  

Q. Do you treat your rosacea patients with intense pulsed light? If yes, is this in combination with other treatments? 

A. I use a pulsed dye laser to treat telangiectases in rosacea. If the patient has other rosacea phenotypes like papules and pustules, then I use treatments that address those, too.  

Q. What advice do you have for your fellow dermatologists treating rosacea?

A. Remember that you don’t want even one rosacea papule on your face and that you don’t want a chronically red face. Work hard with and for your patients to get them as close to clear as possible. These patients don’t just want to be better, they want to be clear.

Q. What is your involvement with NRS? Why is the organization of value to dermatologists and patients living with rosacea?  

A. I have been involved with the NRS for many years, assisting in the grant application/selection process. NRS is a valuable educational resource for our patients with rosacea and offers grant support to investigators studying rosacea. 

Reference

1. Gallo RL, Granstein RD, Kang S, et al. Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. 2018;78(1):148-155.