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July 2012 www.PharmacyTimes.com 110 Introduction Rosacea is a common chronic skin con- dition characterized by redness of the face. Of the approximately 16 million Americans who are affected by rosacea, many have not been given a diagnosis or have been given an improper diagnosis; the condition is often mistaken for acne. 1 Treatment is not curative; instead, it focuses on symptom management. As with other dermatologic conditions, the visible signs can be quite distressing to patients and may greatly affect qual- ity of life. However, early diagnosis and initiation of treatment, including lifestyle measures and nonprescription and prescription therapy, both topical and systemic, can reduce symptoms, improve patient appearance, and prevent progression of the disease. 2 As health care providers who are highly accessible, pharmacists can be instrumental in assisting patients with rosacea. Strategies may include referral of patients to appropriate health care providers for suspected cases of rosacea, patient education with regard to trig- ger avoidance and treatment strategies, and monitoring of patient progress and outcomes. Pathophysiology of Rosacea The cause of rosacea is generally report- ed to be unknown. It has been proposed that rosacea may be a group of diseases with common symptoms. 3 For a number of years, an infectious cause was sus- pected, which fueled the use of tetracy- clines and metronidazole for treatment. In addition, patients with rosacea exhibit a large number of parasitic Demodex fol- liculorum mites on their skin. Presently, infection is no longer considered the primary cause of rosacea. 2,4,5 The complex pathophysiology of rosa- cea is poorly understood, and much still remains to be explained regarding the interrelationships of the immune system, neurovascular system, genetic factors, microorganisms, blood and lymphatic vessel changes, and the variety of cells and molecules that interact to produce the signs and symptoms of rosacea. 6 In short, the immune, nervous, and vascular systems become overstimulated and dys- regulated, which causes a chronic state of inflammation. An abnormal immune response to trigger events early in the disease process activates other pathways that contribute to the development of rosacea. 4 Current research is investigat- ing dysregulation of a major pathway Understanding and Managing Rosacea in Your Pharmacy CONTINUING EDUCATION 110 PharmacyTimes.org December 2015 Faculty Peggy Piascik, PhD, BSPharm Professor of Pharmacy Practice and Science University of Kentucky College of Pharmacy Lexington, Kentucky Disclosures The following contributor(s) have no relevant financial relationships with commercial interests to dis- close. Faculty Peggy Piascik, PhD, BSPharm Pharmacy Times Continuing Education Planning Staff—David Heckard; Maryjo Dixon, RPh; Beatriz Manzor Mitrzyk, PharmD, BCPS; Dipti Desai, PharmD, RPh; Donna Fausak; Nathalie Harden; and Tara DeLorenzo Pharmacy Times Editorial Staff— Kirk McKay An anonymous peer reviewer was part of the content validation and conflict resolution and has no rel- evant financial relationships with commercial interests to disclose. At the completion of this activity, the participant will be able to: 1. Explain the pathophysiology of rosacea. 2. Examine the signs and symptoms of rosacea. 3. Differentiate between the current treatment options for rosacea. 4. Identify counseling opportunities for rosacea patients. Activity Overview This activity will provide information on the pathophysiology, signs and symptoms, diagnosis, and classifica- tion of subtypes of rosacea. Lifestyle modifications that assist patients in the management of rosacea are addressed. Additionally, therapeutic options, including topical and sys- temic medications, will be discussed. Target audience: Community retail pharmacists Activity Type: Application Release date: December 7, 2015 Expiration date: December 7, 2017 Estimated time to complete activity: 2.0 hours Fee: This lesson is offered free at www.pharmacytimes.org. EDUCATIONAL OBJECTIVES Pharmacy Times Continuing Education is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education. This activity is approved for 2.0 contact hours (0.20 CEUs) under the ACPE universal activity number 0290-0000-15-151-H01-P. The activity is available for CE credit through December 7, 2017. The activity has been supported by an educational grant from Bayer HealthCare Pharmaceuticals Inc.