Non-Pharmacologic Treatment of Rosacea
DESCRIPTION
Rosacea is a chronic inflammatory skin disorder characterized by remissions and exacerbations of erythema, edema, papules, and pustules. Secondary characteristics often appear with one or more of the primary features of rosacea, and may include burning, stinging, plaque, dry appearance, ocular manifestations, and phymatous changes.
Rosacea typically affects the convexities of the central face, but may also be present in other locations. Early treatment may halt or reverse the progression of the disease. If left untreated, rosacea may lead to persistent erythema, telangiectasias, and rhinophyma.
Preventative measures include identification and avoidance of trigger factors. Pharmacologic treatment is generally effective in relieving the signs and symptoms of rosacea and includes topical agents and antibiotics, as well as oral antibiotics. Other treatments that may reduce erythema, telangiectasia and rhinophyma include laser and light therapy, dermabrasion, chemical peels, surgical debulking, and electrosurgery.
POLICY
Non-pharmaceutical treatment of rosacea, including but not limited to laser and light therapy, dermabrasion, chemical peels, surgical debulking and electrosurgery, is considered investigational.
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
The National Rosacea Society assembled a committee to devise a standard method of classifying the symptoms of rosacea and assessing gradations of the severity of rosacea, in order to provide a common reference for diagnosis, treatment, and assessment of results in clinical practice. The four identified subtypes are erythemototelangiectatic, papulopustular, phymatous, or ocular. In addition, one variant has been recognized as granulomatous rosacea. Primary and secondary symptoms and subtypes are graded as absent, mild, moderate, or severe.
There is insufficient evidence regarding the efficacy of non-pharmacologic treatment of rosacea as well as a lack of comparison of these treatments to conventional therapies. While rosacea is a progressive and chronic process, there is no clinical impact on an individual's health status. Non-pharmacologic treatment is primarily performed for cosmetic purposes.
SOURCES
American Academy of Dermatology. (2007, March). The good and bad of “all natural” therapy for rosacea. Retrieved September 15, 2010 from http://www.skincarephysicians.com/rosaceanet/all_natural_therapy.html.
American Academy of Dermatology. (2008, June). Advances changing face of rosacea treatment. Retrieved September 15, 2010 from http://www.skincarephysicians.com/rosaceanet/treatment_advances.html.
American Academy of Dermatology. (2009, December). Rosacea. Retrieved September 15, 2010 from http://www.aad.org/public/publications/pamphlets/common_rosacea.html.
Baldwin,H. (2007). Systemic therapy for rosacea. Skin Therapy Letter. 12 (2), 1 - 5, 9. (Level 5 Evidence)
Blount, B., & Pelletier, A. (2002). Rosacea: a common, yet commonly overlooked, condition. American Family Physician, 66 (3), 435 -440. (Level 5 Evidence)
BlueCross BlueShield Association. Medical Policy Reference Manual. (12:2009). Non-pharmacologic treatment of rosacea. (2.01.71). Retrieved September 14, 2010 from BlueWeb.
Culp, B. & Scheinfeld, N. (2009). Rosacea: A review. P.T, 34 (1), 38 - 45. (Level 5 Evidence)
Gooderham, M. (2009). Rosacea and its topical management. Skin Therapy Letter, 14 (2), 1 -3. (Level 5 Evidence)
Journal of the American Academy of Dermatology. (2004). Standard grading system for rosacea: Report of the National Rosacea Society Expert Committee on the classification and staging of rosacea. Retrieved February 9, 2005 from http://rosacea.org/grading/gradingsystem.pdf.
Morelli, V., Calmet, E. & Jhingade, V. (2010). Alternative therapies for common dermatologic disorders part 1. Primary Care, 37 (2), 269 - 283. (Level 5 Evidence)
Neuhaus, I., Zane, L., & Tope, W. (2009). Comparative efficacy of nonpurpuragenic pulsed dye laser and intense pulsed light for erythematotelangiectatic rosacea. Dermatologic Surgery, 35 (6), 920 - 928. (Level 2 Evidence)
U. S. Food and Drug Administration. (2003, May). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K072564 Retrieved September 14, 2010 from http://www.accessdata.fda.gov/cdrh_docs/pdf7/K072564.pdf
van Zuuren EJ, Graber MA, Hollis S, Chaudhry MMMC, Gupta AK, Gover MD, Interventions for rosacea. Cochrane Database of Systematic Reviews 2005, Issue3. Ar. No.:CD003262. DOI: 10.1002/14651858.CD003262.pub3.
van Zuuren, E., Gupta, A., Gover, M., Graber. M., & Hollis, S. (2007). Systematic review of rosacea treatments. Journal of American Academy of Dermatology, 56 (1), 107 - 115. (Level 5 Evidence)
Wilkin, J., Dahl, M., Detmar, M., Drake, L., Liang, M., Odom, R., et al. (2004). Standard grading system for rosacea: report of the National Rosacea Society Expert Committee on the classification and staging of rosacea. Journal of American Academy of Dermatology, 50 (6), 907 - 912. (Level 5 Evidence)
Winifred S. Hayes, Inc. Medical Technology Directory. (2007, October). Laser and light therapies for rosacea. Retrieved September 14, 2010 from www.Hayesinc.com/subscribers (21 articles and/or guidelines reviewed)
Winifred S. Hayes, Inc. Medical Technology Directory. (2007, October; last update search September 2010). Laser and light therapies for rosacea. Retrieved September 14, 2010 from www.Hayesinc.com/subscribers. (1articles and/or guidelines reviewed)
ORIGINAL EFFECTIVE DATE: 8/13/2005
MOST RECENT REVIEW DATE: 12/9/2010
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