Hilary Baldwin, MD: The Surge of Rosacea Treatment Options

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In the span of a decade, agents like topical ivermectin, minocycline and benzoyl peroxide has provided more opportunities to achieve clear skin for rosacea patients.

Hilary Baldwin, MD, recalls the first meeting of the American Acne and Rosacea Society in May 2012.

“I had a rosacea talk coming up titled, ‘What’s New in Rosacea,’ and I had nothing,” Baldwin joked to HCPLive. “I asked everybody in the room, ‘Do you have something for me?’ And we really didn’t have a whole heck of a lot.”

Twelve years later, that script has flipped.

In an interview with HCPLive during the Maui Derm 2023 NP + PA Summer Conference in Colorado Springs this week, Baldwin, medical director of the Acne Treatment & Research Center in New York, discussed the boom of topical and disease-targeting agents that have come to define modern rosacea management. In fact, in a dozen years, the field has progressed from dormancy to becoming “one of the easiest diseases for me to take care of.”

“We have wonderful new topicla medications, we have our oral medications for the treatment of the papules and pustules of rosacea, we have 2 drugs that work well for the erythema, we have lasers that work well for the erythema and telangiectasias,” Baldwin said. “I’m a happy girl.”

Baldwin particularly highlighted the advent of topical therapies including ivermectin, minocycline, and a new formulation of benzoyl peroxide in the last decade—“all of them far more efficacious and also more tolerable” than their predecessors metronidazole and azelaic acid.

Still, rosacea treatment buy-in and adherence remain a persistent challenge for patients. Baldwin said the length of the chronic disease is generally what will dictate a patient’s waning commitment to topical treatment. Additionally, the severity of disease may ebb and flow during a treatment regimen; patients may believe they can discontinue treatment during a period of well-managed disease, only for it to flare again.

“Fortunately—although it’s a cosmetic emergency—it’s not a medical emergency,” Baldwin said. “They go back on their medication and it works once again.”

Dermatologists are also challenged to convince patients that “better is not really what we’re going for.” New drugs have provided new goals.

“We have ample evidence now that if you go all the way to clear (skin), your chances of staying clear and being able to go on a drug holiday are much improved,” Baldwin said. “In fact, with our newer topical medications, we have some evidence that the recurrence rate across the board is less. There are patients who never seem to have rosacea again, and we just never saw that before.”