LAUSR

Rosacea is a common chronic condition with an estimated global prevalence of 5 46%. It has consequences for the quality of life of those affected and this impact is often underreported. In this issue of the BJD, the British Association of Dermatologists (BAD) guidelines for the management of people with rosacea offer an in-depth examination of the current treatments available and the approach to the management of this condition. Using a systematic review of available evidence these guidelines offer a thorough summary of current best practices. Recommendations were graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system and the BAD’s recommended methodology using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Strong recommendations include the use of topical ivermectin, metronidazole or azelaic acid as first-line therapies for papulopustular rosacea; an oral antibiotic for more severe papulopustular rosacea, with avoidance of minocycline; and appropriate ocular therapy with referral to an ophthalmologist as necessary for ocular rosacea. Some of the benefits of clinical guidelines include providing guidance for clinicians who are uncertain on how to proceed in specific scenarios, updating clinical practice and providing consistency of care, ultimately with the goal of improving health outcomes. However, potential harms have been previously raised, including use in practice litigation, economic and coverage implications, and discouragement of research. Other authors have stated that ‘guidelines are directed at the disease, not at a particular patient. They should not supersede individualized medicine’. The authors of the guidelines in this issue have made an effort to make the patient the focus, rather than the disease; this ethos is reflected in the title of these guidelines and displays the efforts of the BJD to increase active involvement of patient research partners. The inclusion of psychological support for those affected by rosacea is one example of patient-driven care as well as an opportunity for increased multidisciplinary management. As the reach of the BJD increases, the relevance and the impact of the BAD guidelines on rosacea will serve to inform clinical management globally. Although slight differences in national guidelines exist, most are based on similar methodology; those practising in countries without their own unique national clinical guidelines may look to the BAD for aid in clinical decision making. The transition from the categorization of rosacea into clinical subtypes to patient-specific phenotypes is underway as per the recommendations from the global Rosacea Consensus panel, but new research using this classification is still limited. Although these guidelines are based on the traditional classification, it does offer a practical approach for clinicians to incorporate both methodologies as they navigate this transition in practice. The BAD guidelines may serve to assist other countries in their development of pathways of care within the changing approach to classifications of rosacea. We encourage the BJD readership to look through the updated guidelines – they offer not only an update to clinical management of rosacea, but also a patient-centred approach.