Rosacea, a chronic inflammatory skin disorder, has an estimated prevalence of 5.5% among adults globally. A condition affecting the higher skin types, it afflicts those of color. A recent publication identified the prevalence of 2% to 3.9% in all ethnic groups. The incidence may be higher due to misdiagnosis and difficulty in identifying the signs of erythema in the higher skin types.

Although erythema is the most common sign of rosacea (84%), papulo-pustular rosacea negatively affects 46% to 68.5% of the population. Self-diagnosis means many present as acne resistant to over-the-counter skin care or inappropriate in-clinic acne treatments. Acne rosacea as a term is misleading. Misdiagnosis and subsequent damaging treatment and management exacerbate the symptoms. Papulopustular rosacea results from a disrupted barrier, subsequent transepidermal water loss, and bacterial and microorganism invasion. The appearance may present as acne, but it is incumbent on specialists to complete a detailed history and skin assessment to accurately diagnose papulo-pustular rosacea.

The key to improving papulo-pustular rosacea is to focus initially on improving the barrier function and avoiding environmental stimuli. Homecare is vital with the approach on gentle skin care. Moisturizers and strict sun protection are necessary to reduce transepidermal water loss and reactive oxygen species. The use of retinol-based creams and topical antibiotics ameliorate bacterial invasion.

In-clinic treatments should adopt the same gentle approach by avoiding harsh and abrasive treatments that disrupt the barrier even further. Treatments that target barrier repair, stimulating collagen production, and hydration such as light therapy (LED), microneedling, deep tissue massage with supportive homecare will dramatically improve skin health. As a long-term chronic inflammatory skin disorder, for those seeking a long-term improvement, it requires commitment from both the client and the skin care professional. It is a slow process that, with patience, will yield amazing results.