Rosacea

Miranda Wallace¹; Nancy Todes-Taylor²; Margot Whitfeld³

¹Pacific Dermatology, St Leonards, New South Wales, Australia; ²St Leonards Dermatology & Laser, St Leonards, New South Wales, Australia; ³Department of Dermatology, St Vincent's Hospital, Sydney, New South Wales, Australia

Aim: Neurogenic rosacea is a form of rosacea due to neurogenic dysregulation and is characterised by severe facial erythema, burning, stinging and pain sometimes out of proportion to the degree of flushing. It is an uncommon, and often debilitating condition with severe effect on quality of life, and often refractory to traditional rosacea therapies. The intradermal microinjection technique of injecting diluted onabotulinum toxin A into the involved facial pattern can produce a significant improvement in the degree of both flushing and pain, where other therapies have failed.

Methods: A 37-year-old female with long history of facial flushing, burning skin of the cheeks, forehead and chin and conjunctival hyperaemia, was diagnosed with a combination of neurogenic and ocular rosacea. She had previously failed therapies including topical metronidazole, brimonidine, ivermectin, oral doxycycline, beta blockers, alpha blockers, mirtazapine, amitriptyline and vascular laser therapy. In addition, patch testing was performed as well blood evaluation to rule out alternative diagnoses. The onabotulinum toxin A (1.67 units per 0.1 mL) diluted in saline, was injected using multiple sites approximately 1 cm apart, and approximately 0.05 mL per injection site, with 25 units in total used over the upper forehead, cheeks, upper lip and chin areas, which were areas most effected by erythema. An additional 14 IU onabotulinum toxin A (100 IU diluted with 2.5 mL saline) diluted was injected into the glabellar complex.

Results: Improvement of symptoms were noticed by the patient within 2 weeks of the first treatment, and a second treatment, 4 months later was requested because of its efficacy. The Rosacea-specific Quality-of-Life instrument (RosQol) showed improvement from a score of 76 to 58 four months after the first treatment.

Conclusion: Neurogenic rosacea is difficult to treat, and dilute intradermal onabotulinum toxin A, may be beneficial therapy to consider in refractory cases.

James Fuller¹; Cathal O'Connor²; Michelle Murphy²

¹Skin Health Institute, Melbourne, Victoria, Australia; ²South Infirmary Victoria and University Hospital, Cork, Ireland

Aim: Rosacea is a common chronic inflammatory skin disease with a complex aetiology and major psychological impact. Patients with rosacea have higher incidences of embarrassment, social anxiety, depression and decreased quality-of-life (QoL) compared to the rest of the population. In the modern era of internet chat forums and social media platforms, patients can research rosacea anonymously using unverified resources, rendering them susceptible to misinformation and conspiracy theories in their desire to improve their QoL. We aimed to assess the content of rosacea-related misinformation online.

Methods: A formal review of PubMed was performed in January 2023, using the terms ‘rosacea’ AND ‘misinformation’ OR ‘disinformation’ OR ‘conspiracy theory’, along with informal Google searches using combinations of these terms. Information in the form of images and direct quotations was collected from the first 10 pages of each Google search. Further targeted searches were also conducted on social media including Twitter, Facebook, Instagram and TikTok.

Results: Key areas of misinformation identified in the search included mislabelling of rosacea as adult acne; falsehoods about rosacea only occurring in older adults or in individuals with lightly pigmented skin; incorrect causes of rosacea such as makeup or diet; and misleading ‘cures’, some of which may lead to exacerbation of the underlying rosacea.

Conclusion: Patients with rosacea may rely on peer-generated information through online social media and internet platforms due to the major psychological impact of the condition and its incurable nature. Relying on online forums can have negative consequences for patients, due to the rapid spread of false information with a perturbing lack of monitoring or verification. Dermatologists must be aware of the large amount of rosacea misinformation trending online and be prepared to counteract them with evidence to optimize patient care.