Consensus Document
Spanish Consensus Document on the Treatment Algorithm for Rosacea
Documento de consenso español para el algoritmo de tratamiento de la rosácea
M. Sallerasa,
, M. Alegreb, V. Alonso-Useroc, P. Boixedad, J. Domínguez-Silvae, J. Fernández-Herreraf, X. García-Navarrog, N. Jiménezd, M. Llamasf, C. Nadalh, J. del Pozo-Losadai, I. Querolj, I. Salgüerok, M. Schallerl, J. Soto de Delásm
Corresponding author
a Servicio de Dermatología, Hospital Universitario Sagrado Corazón, Barcelona, Spain
b Servicio de Dermatología, Hospital Plató, Barcelona, Spain
c Servicio de Dermatología, Hospital Nisa 9 de Octubre, Valencia, Spain
d Sección de Dermatología, Hospital Ramón y Cajal, Madrid, Spain
e Servicio de Dermatología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
f Sección de Dermatología, Hospital de La Princesa, Madrid, Spain
g Servicio de Dermatología, Consorci Sanitari del Garraf, Barcelona, Spain
h Servicio de Dermatología, Hospital Son Llatzer, Palma de Mallorca, Spain
i Servicio de Dermatología, Hospital Universitario A Coruña, La Coruña, Spain
j Universidad de Zaragoza, Zaragoza, Spain
k Servicio de Dermatología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
l Departamento de Dermatología, Universidad de Klinikum, Tubinga, Germany
m Servicio de Dermatología, Policlínica Gipuzkoa, San Sebastián, Spain
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"apellidos" => "Salgüero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">k</span>" "identificador" => "aff0055" ] ] ] 13 => array:3 [ "nombre" => "M." "apellidos" => "Schaller" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">l</span>" "identificador" => "aff0060" ] ] ] 14 => array:3 [ "nombre" => "J." "apellidos" => "Soto de Delás" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">m</span>" "identificador" => "aff0065" ] ] ] ] "afiliaciones" => array:13 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Sagrado Corazón, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Plató, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Nisa 9 de Octubre, Valencia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Sección de Dermatología, Hospital Ramón y Cajal, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Sección de Dermatología, Hospital de La Princesa, Madrid, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Servicio de Dermatología, Consorci Sanitari del Garraf, Barcelona, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Son Llatzer, Palma de Mallorca, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario A Coruña, La Coruña, Spain" "etiqueta" => "i" "identificador" => "aff0045" ] 9 => array:3 [ "entidad" => "Universidad de Zaragoza, Zaragoza, Spain" "etiqueta" => "j" "identificador" => "aff0050" ] 10 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain" "etiqueta" => "k" "identificador" => "aff0055" ] 11 => array:3 [ "entidad" => "Departamento de Dermatología, Universidad de Klinikum, Tubinga, Germany" "etiqueta" => "l" "identificador" => "aff0060" ] 12 => array:3 [ "entidad" => "Servicio de Dermatología, Policlínica Gipuzkoa, San Sebastián, Spain" "etiqueta" => "m" "identificador" => "aff0065" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Documento de consenso español para el algoritmo de tratamiento de la rosácea" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Rosacea is a common chronic skin disease that causes redness, papules, and pustules mainly on the face. The eyes can also become compromised and the skin may thicken and increase in volume in the phymatous form of the disease.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Although epidemiologic statistics vary, studies in Europe and the United States estimate that the incidence ranges from less than 1% to more than 20% in different general populations.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">2</span></a> However, comparisons are difficult because of variations in methodology. Examples of overall prevalence rates reported are 2.2% for Germany,<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> between 1.3% and 2.1% for the United States,<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">4</span></a> and 22% for Estonia.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Rosacea tends to appear between the ages of 30 and 50 years<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">6</span></a> and more often in women than men,<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">4</span></a> although men are more likely to develop the phymatous form.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">7</span></a> Any racial or ethnic group may be affected, but persons with pale skin have greater propensity.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Few studies have looked at the pathogenesis of rosacea, but some evidence supports the hypothesis that a genetic predisposition plays a key role<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">8,9</span></a> and that changes in the innate immune system are involved. There is also evidence of certain environmental and other predisposing factors, or triggers,<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">2</span></a> among them foods, emotions, or the use of certain topical treatments.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">10</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In spite of the availability of scientific evidence, criteria for diagnosing and treating the disease differ and are not always in accordance with clinical subtypes.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">4</span></a> Recent years have seen many advances in the treatment of facial erythema,<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">11,12</span></a> underlining the need to review and update diagnostic criteria and therapeutic approaches.</p><p id="par0030" class="elsevierStylePara elsevierViewall">This consensus statement was drafted on the basis of guidelines and systematic reviews of the evidence on rosacea, among them the ones published by the American Acne and Rosacea Society<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">13–17</span></a> and the Cochrane study of interventions,<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">8</span></a> which also took supplementary data from a German guideline into consideration. Thus, the present Spanish consensus brings together the latest evidence available,<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a> including studies related to the clinical assessment of the disease, treatment objectives, and therapies. It is meant to provide a point of reference and practice recommendations for dermatologists who treat rosacea. The statement does not include less common and complex forms of the disease, such as those caused by infestations of mites (<span class="elsevierStyleItalic">Demodex</span> species), granulomatous rosacea, or rosacea fulminans. Nor does it discuss the various cosmetic products often used by patients with rosacea (cleansers, moisturizers, sunscreens, etc.). Such products, even though considered necessary by the panel of experts, are not covered by this statement.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">Fifteen dermatologists were selected for the panel of experts on the basis of their level of knowledge and clinical and research experience (<a class="elsevierStyleCrossRef" href="#sec0120">see online supplementary material, in Spanish</a>). One of the experts (M.S.) served as coordinator; the others all participated in the discussion and validation steps.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The coordinator provided a list of topics consisting of clinically important questions that would be addressed by the panel's recommendations. She then collected and interpreted available evidence after a review of the literature and drafted a set of recommendations to submit to the panel of expert dermatologists.</p><p id="par0045" class="elsevierStylePara elsevierViewall">To characterize the approaches the expert panel applied in their own clinical practices, the dermatologists answered 23 questions related to their diagnosis and treatment of the disease (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). (<a class="elsevierStyleCrossRef" href="#sec0120">See online supplementary material, Table S1 for the most important results, in Spanish.</a>) Based on the survey and the review of the literature, the coordinator drafted recommendations on which the panel reached consensus through discussion. Discussion focused mainly on questions about which opinions diverged or for which evidence was lacking.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Search Strategy and Article Selection</span><p id="par0050" class="elsevierStylePara elsevierViewall">The following databases were searched to locate and select articles: MEDLINE/PubMed, the Cochrane Library, and Google Scholar. The search's focus was on finding original and review articles in English or Spanish published between 2002 and 2015. Limiters related to methods were as follows: reviews; case series; prevalence, cohort or case–control studies; nonrandomized and randomized controlled trials; and meta-analyses. All original research had to include patients with rosacea. The articles located were evaluated to identify those with data useful for answering the clinical questions and make recommendations based on the highest available levels of evidence. The CASPe criteria (Critical Appraisal Skills Programme, Spanish version)<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">20</span></a> were used to assess quality and validity. From these criteria the strength of evidence offered by each study was inferred, to determine the level of impact each would have on recommendations.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The panel then assessed the quality of evidence of the results overall and categorized the recommendations according to the GRADE system (Grading of Recommendations Assessment, Development and Evaluation),<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">21</span></a> which provides explicit, systematic classifications. Criteria taken into account in the process of evaluating the level of evidence were methodological shortcomings, consistency of results, generalizability of conclusions, and effect size. Once the literature had been assessed, recommendations were drafted based on the best available evidence, clinical experience, and applicability. The drafted recommendations were then classified and prioritized for implementation in rounds of discussion of the questions posed to the panel of experts.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Procedures for Reaching Consensus</span><p id="par0060" class="elsevierStylePara elsevierViewall">Twenty affirmations were grouped under 4 headings: a) definition of rosacea, b) impact on quality of life (QoL), c) therapeutic approach, and d) treatments. The panel of experts met for open discussion of all the proposed statements, debating each one individually and proposing improvements to incorporate into the final recommendations.</p><p id="par0065" class="elsevierStylePara elsevierViewall">To facilitate the measurement of degree of consensus, the experts rated their agreement with each recommendation on a Likert scale.<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">22</span></a> If at least 75% of them agreed or totally agreed with an item, consensus was assumed. In the first round of voting, consensus was reached on 17<span class="elsevierStyleHsp" style=""></span>recommendations. On 8<span class="elsevierStyleHsp" style=""></span>of them agreement was high. Two other items were validated by consensus after the second round of discussion and assessment. Thus, a total of 19<span class="elsevierStyleHsp" style=""></span>recommendations and 4<span class="elsevierStyleHsp" style=""></span>treatment algorithms, one for each subtype of rosacea, were approved (Fig. 1). (<a class="elsevierStyleCrossRef" href="#sec0120">See Appendix BS1, online supplementary material, in Spanish</a>.) <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> summarizes the consensus-based recommendations issued by the panel of experts after review of the available evidence.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Consensus Regarding the Treatment of Rosacea</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Definition of Rosacea</span><p id="par0070" class="elsevierStylePara elsevierViewall">Rosacea is a common chronic skin disease with variable symptoms that usually affect the convex areas in the center of the face (cheeks, chin, nose, and center of the forehead). This condition includes various cutaneous signs such as transient flushing, nontransient erythema, telangiectasia, edema, papules, pustules, ocular involvement, and phymatous changes. Most patients manifest only a few of these signs, but others may develop more than one manifestation of the disease simultaneously.<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">23</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Four forms, or subtypes, of rosacea are currently designated, as follows: 1, erythematotelangiectatic rosacea, 2, papulopustular rosacea, 3, ocular rosacea, and 4, phymatous rosacea. However, information about their signs and symptoms, the relations between the subtypes, and the potential for progression from one to another remains scant.<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">24</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The experts’ opinion was that although this classification system is clinically unconvincing it is practical for research.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Recommendations:</p><p id="par0090" class="elsevierStylePara elsevierViewall">Rosacea is a common chronic skin disease with variable symptoms that usually affect the central area of the face.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The classification of rosacea into 4<span class="elsevierStyleHsp" style=""></span>subtypes is practical when applied to the results of clinical research.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The clinical subtypes of rosacea are useful for classifying signs and symptoms; however, they do not clarify such aspects as chronicity or disease course in terms of individual clinical features.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Effect on QoL</span><p id="par0105" class="elsevierStylePara elsevierViewall">Rosacea mainly affects the face and its impact on a patient's QoL is indisputable. All studies on QoL in rosacea have shown that patients feel embarrassment and anxiety.<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">25</span></a> They may also experience lack of confidence, low self-esteem, a negative body image, and depression. Understanding the patient's view of QoL is extremely important for disease management and choosing an appropriate treatment. Knowledge of concomitant conditions, such as migraine or gastrointestinal disorders, will also influence choice of therapy.</p><p id="par0110" class="elsevierStylePara elsevierViewall">It is important to bear in mind how long it will take for a treatment's active ingredient to take effect. The duration of treatment should also be taken into account. Finally, each medication's adverse effects must be watched for.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">1</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The rosacea patient is sometimes anxious because of prior experiences with failed therapy or unsatisfactory outcomes. If the response comes slowly, the clinician must insist on waiting until a medication can take effect unless the patient cannot tolerate its adverse effects. Treating an outbreak of rosacea usually takes 6<span class="elsevierStyleHsp" style=""></span>to 8<span class="elsevierStyleHsp" style=""></span>weeks.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Although it is generally said that second-line treatments should only be used once first-line treatments prove insufficient, in fact there are several first-line treatments available and the expert panel found it difficult to agree on a scale of preferences for these topical therapies.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Recommendations:</p><p id="par0130" class="elsevierStylePara elsevierViewall">Rosacea can affect an individual's psychological and social well-being. Bear in mind rosacea's impact on the patient's QoL when deciding how to approach treatment.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Allow time for a treatment to take effect before changing to another one, provided the treatment is tolerated.</p><p id="par0140" class="elsevierStylePara elsevierViewall">If there is no response to a first-line treatment, another first-line treatment can be prescribed or a second-line treatment can be added.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Therapeutic approach</span><p id="par0145" class="elsevierStylePara elsevierViewall">Rosacea should be treated according to subtype. When the subtype is diagnosed, a medication with appropriate active ingredients for that type should be selected. General advice for patients with rosacea includes gentle cleansing, frequent use of a moisturizer, and routine use of sunscreens with a protection factor between 30 and 50. These measures and the elimination or attenuation of aggravating factors of climate and diet, for example, are very important for managing common symptoms such as dryness, pruritus, or a burning sensation. Members of the panel of experts acknowledged them in discussion, although they were not specifically evaluated.</p><p id="par0150" class="elsevierStylePara elsevierViewall">How is maintenance therapy approached? Is it always necessary? Is it provided only if the patient asks for it? The chronic nature of rosacea justifies the use of some type of maintenance therapy appropriate for the patient's course of disease. Some patients enter into remission and remain so for long periods, whereas others experience many relapses within short periods of time. A maintenance treatment can keep a patient free of lesions for between 1<span class="elsevierStyleHsp" style=""></span>and 3<span class="elsevierStyleHsp" style=""></span>years, depending on severity. Tailoring is necessary. The physician's attitude and recommendation will be relevant, but the final decision is the patient's. The goal is to reduce the likelihood of recurrence. Although a topical treatment is usually prescribed, the patient's preference must be considered.</p><p id="par0155" class="elsevierStylePara elsevierViewall">A combination of topical and oral therapy is optimal in moderate to severe rosacea. Both the physician and patient's view of severity are relevant, along with how quickly the patient desires to see results.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">17</span></a>)</p><p id="par0160" class="elsevierStylePara elsevierViewall">Recommendations:</p><p id="par0165" class="elsevierStylePara elsevierViewall">Choice of a maintenance therapy should be individualized. Give preference to the least aggressive therapy that achieves control of symptoms.</p><p id="par0170" class="elsevierStylePara elsevierViewall">Prescribe more than one treatment when the signs or symptoms of rosacea are severe.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Treatment</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Erythema and telangiectasia: subtype 1 rosacea</span><p id="par0175" class="elsevierStylePara elsevierViewall">Facial erythema, whether it is a constant, underlying presence (not transient) or appears occasionally either as a result of a clear trigger factor or without one (transient erythema, also known as flushing), is probably the most common feature of rosacea and one of the greatest concerns from the patient's point of view.</p><p id="par0180" class="elsevierStylePara elsevierViewall">Erythema might respond sufficiently well to the application of topical α2 adrenergic receptor agonists, which induce the constriction of superficial vessels and attenuate underlyling erythema for several hours; however, they do not act on telangiectasia.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">17</span></a> Laser and other light therapies such as intense pulsed light (IPL) treatments can also be prescribed for erythema and are the main treatments for telangiectasia.<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">17,18</span></a></p><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Transient erythema (flushing).</span><p id="par0185" class="elsevierStylePara elsevierViewall">Topical brimonidine tartrate in a 0.5% gel formulation applied once daily in the morning has been evaluated in 2 randomized double-blind controlled trials (phase 3) that compared the active formulation to vehicle for the treatment of moderate to severe erythema in rosacea whether transient (flushing) or permanent.<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">11,26</span></a> The trials demonstrated the formulation was effective in around 70% of patients. Onset of effect occurs about 30<span class="elsevierStyleHsp" style=""></span>minutes after application. The peak effect is between 3 and 9<span class="elsevierStyleHsp" style=""></span>hours later, and it decreases until it disappears at about 12<span class="elsevierStyleHsp" style=""></span>hours. Brimonidine is therefore indicated to treat the facial redness of rosacea<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">27,28</span></a> as a first-line option. However, even though it is considered the most significant advance in the treatment of transient erythema to date, it is poorly tolerated by some patients. Furthermore, it is important to note that brimonidine offers symptomatic, not definitive therapy for the disease, a point that is made in the summary of product characteristics.<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">29</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">Laser and other light therapies (by themselves or in combination with brimonidine) continue to be the main options in the therapeutic arsenal against erythema,<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">27,30</span></a> even though these physical treatments are more effective against telangiectasia and less effective against erythema. In particular, when known trigger factors are involved, light therapies only lead to partial improvement.</p><p id="par0195" class="elsevierStylePara elsevierViewall">Flushing can also be treated with oxymetazoline 1% cream and oral clonidine, β-blockers (propranolol, carvedilol), naloxone or ondansetron. However, only limited evidence supports this use of these agents.<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">28</span></a> The panel of experts supported the use of oral β-blockers and other antihypertensive drugs as off-label, second-line treatments for transient erythema.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Nontransient (permanent) erythema.</span><p id="par0200" class="elsevierStylePara elsevierViewall">Nontransient facial erythema in rosacea can respond to specific laser or other light therapies such as pulsed dye laser (PDL) and IPL,<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">16</span></a> which have been shown to have similar effects.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a> Brimonidine monotherapy as a symptomatic treatment for permanent erythema can also be a good choice.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a> The panel of experts recommended combining PDL or IPL with brimonidine as a first line of therapy.</p><p id="par0205" class="elsevierStylePara elsevierViewall">Some of the antihypertensive agents mentioned above can be used to treat permanent as well as transient erythema. β-blockers, which act as vasoconstrictors on cutaneous arteries by blocking the β<span class="elsevierStyleInf">2</span>-adrenergic pathway, are used off label for erythema.<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">31</span></a> The experts, who reported having only slight experience with these drugs, advised using vascular laser therapy first, saving oral β-blockers off label as a second-line option for permanent erythema.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Telangiectasia</span><p id="par0210" class="elsevierStylePara elsevierViewall">Both PDL and IPL treatments have beneficial effects on telangiectasia.<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">30</span></a> These 2 types of light therapy are first-line treatment choices and can be used in combination.</p><p id="par0215" class="elsevierStylePara elsevierViewall">The experts disagreed regarding the use of electrodesiccation on telangiectasia. If no other technique is available, it is possible to obtain good results with the electric scalpel in the right hands, although electrodesiccation is not generally considered to be a first-choice tool for this purpose. Therefore, the experts placed it among second-line treatments.</p><p id="par0220" class="elsevierStylePara elsevierViewall">Recommendations:</p><p id="par0225" class="elsevierStylePara elsevierViewall">Topical brimonidine or oral β-blockers can be considered for treating transient erythema (flushing).</p><p id="par0230" class="elsevierStylePara elsevierViewall">PDL and IPL therapy are the first-choice treatments for nontransient erythema; brimonidine can be used for symptomatic treatment.</p><p id="par0235" class="elsevierStylePara elsevierViewall">IPL and laser treatments are first-line choices for telangiectasia.</p><p id="par0240" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> summarizes the experts’ consensus on the treatment of erythematotelangiectatic rosacea (subtype 1).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Papulopustular rosacea: subtype 2</span><p id="par0245" class="elsevierStylePara elsevierViewall">First-line treatments for mild inflammatory papulopustular lesions include topical ivermectin or metronidazole and oral doxycycline, although their efficacy is not exactly the same in this clinical setting.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">1</span></a></p><p id="par0250" class="elsevierStylePara elsevierViewall">European and other international consensus statements include azelaic acid as a first-line treatment,<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">17,18</span></a> but the expert panel reported that surveys of Spanish practitioners indicate that few of them consider this option first. Instead, they use it as a complementary therapy or a maintenance treatment between exacerbations. Therefore, they choose mainly between metronidazole and ivermectin.<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">14,32</span></a> Sulfacetamide in association with a bisulfite is also routinely used in some countries, such as the United States, but these products are not available in Spain.</p><p id="par0255" class="elsevierStylePara elsevierViewall">Dermatologists routinely use metronidazole and ivermectin based on their clinical experience and patient characteristics such as adherence to prescription, socioeconomic level, and health care coverage. One randomized investigator-blinded trial (phase<span class="elsevierStyleHsp" style=""></span>2) with 960 patients found that ivermectin<span class="elsevierStyleHsp" style=""></span>1% cream once daily was superior to metronidazole<span class="elsevierStyleHsp" style=""></span>0.75% cream twice daily after 16<span class="elsevierStyleHsp" style=""></span>weeks of treatment (83.0%<span class="elsevierStyleHsp" style=""></span>vs 73.3%, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001) and that ivermectin's efficacy tended to improve with time, even in patients with more severe disease.<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">32</span></a> Ivermectin's safety and tolerance profile was also superior to that of metronidazole in that study.</p><p id="par0260" class="elsevierStylePara elsevierViewall">Stein Gold et al<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">12</span></a> compared the safety of long-term use of ivermectin 1% cream and azelaic acid<span class="elsevierStyleHsp" style=""></span>15% gel as maintenance treatments for papulopustular rosacea in 40-week investigator-blinded extensions of 2 prior phase-3 trials. They reported that more outcomes were recorded as “clear or almost clear” (investigator's global assessment) in the ivermectin group than in the azelaic acid group. Safety and tolerance during follow-up were also better in the ivermectin group.</p><p id="par0265" class="elsevierStylePara elsevierViewall">Topical therapy is usually adequate for treating mild papulopustular rosacea. However, moderate to severe disease usually requires the addition of systemic therapy.<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">17,19</span></a> Ivermectin, metronidazole, and azelaic acid were once again the first-line choices for papulopustular lesions and moderately intense perilesional erythema.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">17</span></a> Tetracyclines were also first-line options.</p><p id="par0270" class="elsevierStylePara elsevierViewall">Some studies have evaluated metronidazole or azelaic acid in combination with oral doxycycline, finding that combined topical and systemic therapy is more effective than topical therapy alone, without causing a rise in adverse effects.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">14</span></a> Likewise, phase-3 studies have shown that an anti-inflammatory (subantimicrobial) doxycycline dose (40<span class="elsevierStyleHsp" style=""></span>mg/d) can be used as a first-line treatment in monotherapy for papulopustular rosacea.<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">34</span></a> In fact US and German guidelines recommend this approach for treating this subtype of the disease.<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">15,18</span></a></p><p id="par0275" class="elsevierStylePara elsevierViewall">Del Rosso et al<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">17</span></a> compared the safety and efficacy of an anti-inflammatory dose of a slow-release formulation of doxycycline (40<span class="elsevierStyleHsp" style=""></span>mg) versus an antimicriobial dose (100<span class="elsevierStyleHsp" style=""></span>mg/d) over a period of 16<span class="elsevierStyleHsp" style=""></span>weeks. The prospective, randomized controlled multicenter trial enrolled 96 patients and led to the conclusion that both doses were equally effective in treating severe rosacea, although an advantage of the lower dose was that it was associated with fewer adverse effects and did not contribute to the development of resistance.<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">35</span></a> A US consensus report also concluded that resistance was avoided by prescribing the 40-mg dose.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">17</span></a></p><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Controversy over antibiotic use in rosacea</span><p id="par0280" class="elsevierStylePara elsevierViewall">The controversy surrounding the use of antimicrobial doses (50–200<span class="elsevierStyleHsp" style=""></span>mg) of tetracyclines versus an anti-inflammatory dose (40<span class="elsevierStyleHsp" style=""></span>mg) was fully discussed during the consensus meeting.</p><p id="par0285" class="elsevierStylePara elsevierViewall">Anti-inflammatory treatment is considered the most appropriate choice for managing rosacea, particularly the papulopustular form, given that rosacea is an inflammatory disease, not an infectious one. However, the panel of experts recognized that clinicians routinely continue to prescribe antibiotics at antimicrobial doses. Oral doxycycline (50–200<span class="elsevierStyleHsp" style=""></span>mg/d) is still the most common prescription in cases that respond poorly to a reasonable trial period of topical treatment. Only occasionally is a subantimicrobial dose of doxycycline (40<span class="elsevierStyleHsp" style=""></span>mg/d) prescribed.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">17</span></a> Minocycline (100<span class="elsevierStyleHsp" style=""></span>mg/d) is another tetracycline that is widely used and has been shown to be effective in papulopustular rosacea.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a> Other tetracyclines are also used in countries where they are available.</p><p id="par0290" class="elsevierStylePara elsevierViewall">Patients who are allergic, intolerant, or resistant to tetracyclines or who have contraindications for their use (pregnancy or age under 10 years) can take macrolides such as erythromycin, clarithromycin, or azithromycin. Oral erythromycin at a dose of 250<span class="elsevierStyleHsp" style=""></span>to 1000<span class="elsevierStyleHsp" style=""></span>mg/d is considered highly effective, although due to adverse effects it is not usually recommended.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a> Other macrolides are preferred.</p><p id="par0295" class="elsevierStylePara elsevierViewall">Although international consensus tends to frown on the use of antimicrobial doses of antibiotics for rosacea,<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">17,18</span></a> given that antibiotics are of interest solely for their anti-inflammatory effect, which can be achieved with a low dose (40<span class="elsevierStyleHsp" style=""></span>mg in the case of doxycycline), this panel of experts insisted that a dose of 100<span class="elsevierStyleHsp" style=""></span>mg was more effective in their experience and that the ideal approach would probably be to prescribe high doses of tetracyclines at the start of treatment and a low dose (40<span class="elsevierStyleHsp" style=""></span>mg/d) for maintenance. Fewer adverse effects (such as candidiasis or the development of resistance) are associated with the lower dose. The experts indicated that although this approach was the most recommendable, it did not always coincide with clinical practice.</p><p id="par0300" class="elsevierStylePara elsevierViewall">Severe cases of rosacea, or refractory ones after a trial of standard therapy, can be treated with oral isotretinoin, whose efficacy in severe rosacea has been demonstrated.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a> Once poor adherence to other therapies has been ruled out in patients with papulopustular rosacea refractory to treatment, oral isotretinoin can be prescribed<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">17</span></a> at lower doses (0.25<span class="elsevierStyleHsp" style=""></span>mg/kg/d) than those indicated for acne. A difference, however, is that isotretinoin attenuates rosacea activity while it is being taken but does not cure the condition as it does acne.</p><p id="par0305" class="elsevierStylePara elsevierViewall">Finally, laser therapies (eg, with PDL and neodymium-YAG [yttrium-aluminum-garnet]) and IPL treatments are effective in severely and persistently dilated superficial blood vessels that do not respond to medications used to treat papules and pustules.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">16</span></a> This approach addresses both linear telangiectasia and more confluent networks of vessels.</p><p id="par0310" class="elsevierStylePara elsevierViewall">Recommendations:</p><p id="par0315" class="elsevierStylePara elsevierViewall">Topical agents such as ivermectin and metronidazole are the first-line recommendations for treating rosacea with mild inflammatory lesions (papules and pustules). Oral doxycycline can be considered an alternative.</p><p id="par0320" class="elsevierStylePara elsevierViewall">Topical agents such as ivermectin and metronidazole and oral doxycycline are the first-line recommendations for treating rosacea with moderately severe inflammatory lesions (papules and pustules).</p><p id="par0325" class="elsevierStylePara elsevierViewall">Systemic treatment (doxycycline or isotretinoin) with or without associated topical therapy (ivermectin or metronidazole) or physical treatments are the first-line recommendations for rosacea with severe inflammatory lesions (papules and pustules).</p><p id="par0330" class="elsevierStylePara elsevierViewall">If tetracyclines are considered for the inflammatory lesions of rosacea, the minimum effective dose of doxycycline is recommended in order to minimize the risk of bacterial resistance.</p><p id="par0335" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> summarizes the experts’ consensus on the treatment of papulopustular rosacea (subtype 2).</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Phymatous rosacea: subtype 3</span><p id="par0340" class="elsevierStylePara elsevierViewall">Active phymatous lesions (with inflammation)</p><p id="par0345" class="elsevierStylePara elsevierViewall">Both doxycycline and isotretinoin have proven effective in the treatment of active phymatous rosacea.<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">15,19</span></a> Isotretinoin is prescribed at low doses (0.1–0.5<span class="elsevierStyleHsp" style=""></span>mg/kg/d) for 6<span class="elsevierStyleHsp" style=""></span>to 8<span class="elsevierStyleHsp" style=""></span>months<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">19,36</span></a> and has been shown to have the potential to slow phymatous progression.<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">37</span></a> Some of these cited authors have thought that combinations of laser vascular surgery, doxycycline, and isotretinoin can be beneficial when more than one subtype of rosacea is present. Good results have also been reported for IPL therapy in clinical trials according to one update.<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">30</span></a></p><p id="par0350" class="elsevierStylePara elsevierViewall">The panel of experts recommended combining vascular laser or IPL treatments with oral doxycycline or isotretinoin (off label) in patients with active phymatous rosacea. Other oral antibiotics or antiparasitic agents (metronidazole and others) are second-line treatments, according to the experts.</p><p id="par0355" class="elsevierStylePara elsevierViewall">A maintenance regimen should be prescribed to prevent the reemergence of symptoms. The panel of experts advised using topical agents such as ivermectin, metronidazole, and azelaic acid.</p><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Stable or inactive phymatous rosacea.</span><p id="par0360" class="elsevierStylePara elsevierViewall">The evidence suggests that phymatous changes should be treated with physical (surgical or laser) therapies.<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">16,18</span></a> No definitively effective medical treatment is available for fully developed phymatous changes in rosacea. However, this form of the disease is routinely managed with the aforementioned therapies, which are sometimes used in combination with tangential excision and dermabrasion. Certain options — such as the electric scalpel and electrosurgery, laser ablation, and scissor sculpting — have been abandoned.<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">16,18</span></a></p><p id="par0365" class="elsevierStylePara elsevierViewall">Recommendations:</p><p id="par0370" class="elsevierStylePara elsevierViewall">Systemic treatment with doxycycline or isotretinoin is the first-line recommendation for active phymatous lesions.</p><p id="par0375" class="elsevierStylePara elsevierViewall">Surgical procedures such as dermabrasion, electrodesiccation, or laser treatments are recommended as first-line treatments for phymatous lesions without clinical inflammation. Scanned or pulsed carbon dioxide laser in continuous mode is preferred because sculpting and hemostasis can be accomplished simultaneously.</p><p id="par0380" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> summarizes the experts’ consensus on the treatment of phymatous rosacea (subtype 3).</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Ocular involvement in rosacea: subtype 4</span><p id="par0385" class="elsevierStylePara elsevierViewall">Ocular involvement develops in 30% to 50% of patients with rosacea. Local ophthalmologic treatment may be sufficient in mild cases. Cleansing the edges of the eyelids is an option, as is the use of artificial tears containing lipids.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a></p><p id="par0390" class="elsevierStylePara elsevierViewall">Some agents (topical corticosteroids, metronidazole 0.75%, and ciclosporin 0.05% twice daily) have proven effective in reducing local ocular inflammation in this type of rosacea.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a> When eye symptoms persist, doxycycline (50–100<span class="elsevierStyleHsp" style=""></span>mg, twice daily or at an anti-inflammatory dose of 40<span class="elsevierStyleHsp" style=""></span>mg/d) have given good results.<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">15,18</span></a> Low-dose isotretinoin (10<span class="elsevierStyleHsp" style=""></span>mg/d) also improves ocular symptoms.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a></p><p id="par0395" class="elsevierStylePara elsevierViewall">According to the panel of experts, neither ciclosporin nor short-term corticosteroid regimens are much used to treat ocular rosacea in Spain. The specialists preferred topical metronidazole and tetracyclines or oral tetracyclines.</p><p id="par0400" class="elsevierStylePara elsevierViewall">The dermatologists thought that they might enter into conflict with ophthalmologists in the treatment of ocular rosacea, and meetings between the 2 types of specialists could be advisable. Patients with mild ocular rosacea are currently treated by dermatologists, whereas those with moderate to severe symptoms are referred to ophthalmologists.</p><p id="par0405" class="elsevierStylePara elsevierViewall">Recommendations:</p><p id="par0410" class="elsevierStylePara elsevierViewall">Dermatologists should be able to recognize the ocular manifestations of rosacea. Patients with altered vision, conjunctival involvement, or signs of corneal involvement should be referred to an ophthalmologist.</p><p id="par0415" class="elsevierStylePara elsevierViewall">The treatment of ocular rosacea depends on severity. General measures to take are adequate cleansing, the application of topical metronidazole, tetracyclines, or ciclosporin), and systemic therapy (doxycycline, short-term corticosteroids, or isotretinoin).</p><p id="par0420" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a> summarizes the experts’ consensus on the treatment of ocular rosacea (subtype 4).</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span></span></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Limitations</span><p id="par0425" class="elsevierStylePara elsevierViewall">A general limitation of the Delphi method is that consensus about various clinical scenarios can be biased by participants’ experience in medical practices where they work. However, the subjective opinion of a panel of experts will always offer higher quality guidance than the opinion of a single specialist, given that the group can pool more information. The literature search to find available evidence for this report was not systematic. Rather it was directed by the clinical questions proposed by the coordinator. Furthermore, articles published after 2016 were not included. Therefore, it is possible that new studies may have changed some of the therapeutic suggestions for rosacea.</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusions</span><p id="par0430" class="elsevierStylePara elsevierViewall">Rosacea is treated according to the severity of the clinical presentation (signs and symptoms), in which the features of different subtypes of the disease are often found in combination. Along with general measures for cleansing and hydrating the skin, the dermatologist usually offers a combination of pharmacologically active agents, as described in this paper. Specialists are increasingly more aware of the impact of rosacea on quality of life, leading them to involve the patient in therapeutic decision-making.</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Funding</span><p id="par0435" class="elsevierStylePara elsevierViewall">Galderma helped to fund the meeting of the panel of experts. This pharmaceutical laboratory did not participate in the writing of the article.</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicts of Interest</span><p id="par0440" class="elsevierStylePara elsevierViewall">Monserrat Salleras has worked with Galderma to coordinate and participate in meetings to reach consensus on the treatment of rosacea. She was also a speaker during the launch of brimonidine and has given talks to provide updated information on rosacea for dermatology teams at Hospital Universitario Sagrat-Cor. She has also received funding for travel to and registration for dermatology conferences. Regarding the preparation of this article, she declares that she has no conflicts of interest related to the treatments proposed, which she defends exclusively based on her clinical experience. Marta Alegre has been a speaker for Galderma twice; she has also served on 2 Galderma advisory boards. Vicent Alonso Usero, Pablo Boixeda, and Jesús Domínguez Silva declare that they have no conflicts of interest related to Galderma. Jesús Fernández Herrera has been a speaker for Galderma; he declares that he has no other conflicts of interest. He has not participated in clinical trials or received funding for travel to or registration for dermatology conferences; nor has he received research grants. Xavier García Navarro declares that he has no conflicts of interest related to Galderma. Natalia Jiménez declares that she served on 2 Galderma advisory boards. Mar Llamas has been a speaker for Galderma on occasion. She has no other conflicts of interest to declare in relation to the rosacea treatments discussed in this consensus paper. She has not participated in clinical trials for Galderma or received funding for travel to or registration for dermatology conferences; nor has she received research grants. Cristina Nadal spoke at a meeting organized by Galderma and served on an advisory board to reach consensus regarding rosacea. Jesús del Pozo Losada declares that he has no conflicts of interest. Ignacio Querol and Irene Salgüero declare that they have no conflicts of interest in relation to Galderma. Martin Schaller has served on advisory boards organized by Bayer, Galderma, and Marpinion within the last 2<span class="elsevierStyleHsp" style=""></span>years. He has also received speaker's fees from AbbVie, Bayer Healthcare, Galderma, and La Roche-Posay. Jorge Soto de Delás has been a speaker for Galderma; he declares that he has not participated in trials of Galderma's products. Nor has he received funding for travel to or registration for dermatology conferences or been awarded research grants.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1237833" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1149012" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1237832" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1149013" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Search Strategy and Article Selection" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Procedures for Reaching Consensus" ] ] ] 6 => array:3 [ "identificador" => "sec0025" "titulo" => "Consensus Regarding the Treatment of Rosacea" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Definition of Rosacea" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Effect on QoL" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Therapeutic approach" ] 3 => array:3 [ "identificador" => "sec0045" "titulo" => "Treatment" "secciones" => array:4 [ 0 => array:3 [ "identificador" => "sec0050" "titulo" => "Erythema and telangiectasia: subtype 1 rosacea" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0055" "titulo" => "Transient erythema (flushing)." ] 1 => array:2 [ "identificador" => "sec0060" "titulo" => "Nontransient (permanent) erythema." ] 2 => array:2 [ "identificador" => "sec0065" "titulo" => "Telangiectasia" ] ] ] 1 => array:3 [ "identificador" => "sec0070" "titulo" => "Papulopustular rosacea: subtype 2" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0075" "titulo" => "Controversy over antibiotic use in rosacea" ] ] ] 2 => array:3 [ "identificador" => "sec0080" "titulo" => "Phymatous rosacea: subtype 3" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0085" "titulo" => "Stable or inactive phymatous rosacea." ] ] ] 3 => array:2 [ "identificador" => "sec0090" "titulo" => "Ocular involvement in rosacea: subtype 4" ] ] ] ] ] 7 => array:2 [ "identificador" => "sec0095" "titulo" => "Limitations" ] 8 => array:2 [ "identificador" => "sec0100" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0105" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0110" "titulo" => "Conflicts of Interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-08-03" "fechaAceptado" => "2019-01-01" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1149012" "palabras" => array:7 [ 0 => "Rosacea" 1 => "Brimonidine" 2 => "Metronidazole" 3 => "Doxycycline" 4 => "Light sources" 5 => "Isotretinoin" 6 => "Ivermectin" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1149013" "palabras" => array:7 [ 0 => "Rosácea" 1 => "Brimonidina" 2 => "Metronidazol" 3 => "Doxiciclina" 4 => "Fuentes de luz" 5 => "Isotretinoína" 6 => "Ivermectina" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Recent scientific evidence and the incorporation of new drugs into the therapeutic arsenal against rosacea have made it necessary to review and update treatment criteria and strategies. To this end, a panel of 15 dermatologists, all experts in rosacea, was formed to share experiences and discuss treatment options, response criteria, and changes to treatment. Based on a critical review of the literature and a discussion of the routine practices of Spanish dermatologists, the panel proposed and debated different options, with consideration of the experience of professionals and the preferences of patients or equality criteria. Following validation of the proposals, the final recommendations were formulated and, together with the evidence from the main international guidelines and studies, used to produce this consensus document. The goal of this consensus document is to provide dermatologists with practical recommendations for the management of rosacea.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Las últimas evidencias científicas y la incorporación de nuevos fármacos al arsenal terapéutico de la rosácea hacen necesario revisar y actualizar los criterios y estrategias de tratamiento. Con este fin, un grupo de 15 dermatólogos expertos en esta enfermedad aportaron y discutieron acerca de las diferentes terapias y los criterios de respuesta y cambio de tratamiento. Partiendo de la revisión crítica de la bibliografía y de la exposición de los hábitos de los dermatólogos españoles en su práctica clínica, se formularon distintas propuestas que fueron debatidas teniendo en consideración tanto la experiencia profesional como las preferencias de los pacientes o los criterios de equidad. Una vez validadas las propuestas, se formularon las recomendaciones finales que, junto con la evidencia aportada por las principales guías y estudios internacionales, dieron lugar al presente documento. El objetivo de este consenso es ofrecer al dermatólogo un enfoque práctico para abordar la rosácea.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as: Salleras M, Alegre M, Alonso-Usero V, Boixeda P, Domínguez-Silva J, Fernández-Herrera J, et al. Documento de consenso español para el algoritmo de tratamiento de la rosácea. Actas Dermosifiliogr. 2019;110:533–545.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0450" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0120" ] ] ] ] "multimedia" => array:8 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Abbreviation: DLQI, Dermatology Quality of Life Index.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">To be answered by the expert dermatologists \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">1. Dermatologist's affiliation: __________</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Indicate your age group: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31–40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41–50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">> 50 y \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Province where you work: __________ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Type/location of your dermatology practice: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Private practice \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">National health service (public sector) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Both \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">2. Which type of practice accounts for most of your caseload?</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Private practice \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">National health service (public sector) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">3. How many patients do you treat every week on average?</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">< 30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Between 30 and 50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">> 50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">4. Approximately how many patients do you treat for problems related to rosacea in a typical week?</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0–5 per week \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5–10 per week \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10–15 per week \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>15 per week \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">5. Rosacea is classified as follows: erythematotelangiectatic, papulopustular, phymatous, and ocular. Do you agree with this classification?</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes (If yes, do you use this classification in your clinical practice?) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No (If not, specify the classification you use in your clinical practice.) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">6. What criteria do you use to determine the severity of a patient's rosacea?</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical subtype, as indicated above \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Number of lesions (in cases of papulopustular rosacea) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Impact on quality of life (DLQI) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">7. How do you proceed in cases of subtype 1 rosacea (erythematotelangiectatic)?</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Only treat if the patient requests it (DLQI) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Suggest treatment if signs are evident \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Always treat, as there is risk of developing papulopustular rosacea \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Do not treat \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">8. In cases of subtype 2 rosacea (papulopustular)</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">How many lesions would you say indicate a mild case? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0–10 lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11–20 lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">> 20 lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">How many lesions would you say indicate a moderate level of severity? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0–10 lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11–20 lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">> 20 lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">How many lesions would you say indicate a severe case? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0–10 lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11–20 lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">> 20 lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Does the development of nodules/granulomas change your perception of severity in rosacea? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes, I immediately judge the case to be severe \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes, I consider rosacea with 2 or more nodules to be severe \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes, I consider a case with 3 or more nodules to be severe \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No, the presence of nodules does not alter my perception of severity in rosacea \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">9. What percentage of your patients with rosacea fall into the following levels of severity?</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mild rosacea \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate rosacea \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Severe rosacea \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">10. Is the problem of antibiotic resistance important in your opinion?</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">11. Are dermatologic treatments contributing to antibiotic resistance in your opinion?</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">12. When you select an approach to treating rosacea, do you consider antibiotics?</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">13. What treatments do you usually prescribe for rosacea? (active ingredients)</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Topical: Metronidazole \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Azelaic acid \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ivermectin \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clindamycin \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Erythromycin \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sulfacetamide \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Other \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral: Minocycline \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Doxycycline 40 mg \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Doxycycline 50/100/200 mg \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Metronidazole \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Macrolides (erythromycin, clarithromycin, azithromycin) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Other \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">14. For what period do you instruct the patient to use topical antibiotic therapy for rosacea on average?</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0–1.5 mo \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.5–3 mo \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3–2 mo \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Indefinitely \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">15. For how long do you prescribe oral antibiotic therapy for rosacea on average?</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0–1.5 mo \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.5–3 mo \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3–12 mo \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Indefinitely \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">16. What effect are you seeking when you prescribe an oral or topical antibiotic for rosacea?</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Anti-inflammatory \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antibacterial \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Both \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">17. Which of the following statements describe your reasons for prescribing a topical antibiotic for rosacea?</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">It is necessary for treating a disease in which mites are a contributing factor. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I only prescribe topical antibiotics for their anti-inflammatory effect. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I don’t feel comfortable not using using an antibiotic to treat an infectious disease. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients ask for antibiotic treatment. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">It's what I’m used to doing. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">18. Which of the following statements describe your reasons for prescribing an oral antibiotic for rosacea?</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">It is necessary for treating a disease in which mites are a contributing factor. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I only prescribe topical antibiotics for their anti-inflammatory effect. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I don’t feel comfortable not using using an antibiotic to treat an infectious disease. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patients ask for antibiotic treatment. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">It's what I’m used to doing. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The subantimicrobial dose of doxycycline (40<span class="elsevierStyleHsp" style=""></span>mg) is effective for the papulopustular lesions of rosacea and does not induce resistance. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">19. What is your main reason for prescribing oral isotretinoin?</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Failure of oral antibiotics \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">I don’t want to use oral antibiotics because rosacea is not an infectious disease. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Severity of rosacea \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient's request \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">20. Do you take into account the following factors when you prescribe an oral isotretinoin? (Mark all that apply.)</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Adverse effects/skin intolerance specific to rosacea \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prior treatment failures \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient's attitude \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Need to prescribe contraceptives (female patient) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Isotretinoin, rather than curing rosacea, attenuates disease activity while it is taken. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Other (please specify) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">21. How do you treat each type of lesion? (If you indicate more than 1 treatment, it is assumed you use them in combination.)</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">First line: __________ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Second line: __________ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maintenance: __________ \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">22. Do you recommend cosmetic products along with conventional medications? (Eg, cleansers, sunscreens, moisturizers, make-up)</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">If you answered yes: What instructions do you give? \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use them before the treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use them after the treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Use them before and after the treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">23. Do you think that there is a complete range of rosacea treatments available at present?</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No. (What gaps must be filled?) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2114498.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Initial Questionnaire to Determine the Profiles of the Panel of Experts and Their Approaches to Rosacea</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Abbreviations: IPL, intense pulsed light; NA, not applicable.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Recommendation \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Basis for Recommendation \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Quality of Evidence/Strength of Recommendation \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Rosacea is a common chronic skin disease with variable symptoms that usually affect the central area of the face.</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Expert consensus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">The classification of rosacea into 4 subtypes is practical when applied to the results of clinical research.</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Expert consensus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">The clinical subtypes of rosacea are useful for classifying signs and symptoms; however, they do not clarify such aspects as chronicity or the course of disease as it is expressed in individual features of the disease.</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Expert consensus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Rosacea can affect an individual's psychological and social well-being. Dermatologists should bear in mind rosacea's impact on the patient's quality of life when deciding on a treatment approach.</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Evidence based<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">25</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate qualityStrong recommendation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Allow time for a treatment to take effect before changing to another one, provided the treatment is tolerated.</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Expert consensus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">If there is no response to a first-line treatment, another first-line treatment can be prescribed or a second treatment can be added.</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Expert consensus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Choice of a maintenance therapy should be individualized. Give preferenceto the least aggressive therapy that achieves control of symptoms.</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Expert consensus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Prescribe more than one treatment when the signs or symptoms of rosacea are severe.</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Expert consensus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Topical brimonidine or oral β-blockers can be considered for treating transient erythema (flushing).</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Evidence based<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">11,26</span></a><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Expert consensus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High qualityStrong recommendationNA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Pulsed dye laser and IPL therapy are the first-choice treatments for nontransient erythema; brimonidine can be used for symptomatic treatment.</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Evidence based<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High qualityStrong recommendation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">IPL and laser treatments are first-line choices for telangiectasia.</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Expert consensus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Topical agents such as ivermectin and metronidazole are the first-line recommendations for treating rosacea with mild inflammatory lesions (papules and pustules). Oral doxycycline can be considered an alternative.</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Evidence based<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">32,33</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Moderate qualityStrong recommendation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Topical agents such as ivermectin and metronidazole and oral doxycycline are the first-line recommendations for treating rosacea with moderately severe inflammatory lesions (papules and pustules).</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Evidence based<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">15,18,34</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High qualityStrong recommendation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Systemic treatment (doxycycline or isotretinoin) with or without associated topical therapy (ivermectin or metronidazole) or physical treatments are the first-line recommendations for rosacea with severe inflammatory lesions (papules and pustules).</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Evidence based<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">16,19</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High qualityStrong recommendation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">If tetracyclines are considered for the inflammatory lesions of rosacea, the minimum effective dose of doxycycline is recommended in order to minimize the risk of bacterial resistance.</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Evidence based<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">17,18,35</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High qualityStrong recommendation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Systemic treatment with doxycycline or isotretinoin is the first-line recommendation for active phymatous lesions.</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Expert consensus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Surgical procedures such as dermabrasion, electrodesiccation, or laser treatments are recommended as first-line treatments for phymatous lesions without clinical inflammation. Scanned or pulsed carbon dioxide laser in continuous mode is preferred because it affords the ability to sculpt and provide hemostasis simultaneously.</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Expert consensus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Dermatologists should be able to recognize the ocular manifestations of rosacea. Patients with altered vision, conjunctival involvement, or signs of corneal involvement should be referred to an ophthalmologist.</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Expert consensus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">The treatment of ocular rosacea depends on severity. General measures to take are adequate cleansing, the application of topical preparations (metronidazole, tetracyclines, or ciclosporin), and the use of systemic therapy (doxycycline, short-term corticosteroids, or isotretinoin).</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Expert consensus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2114496.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Recommendations Issued by the Panel of Experts</p>" ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Abbreviations: IPL, intense pulsed light; PDL, pulsed dye laser.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Transient Erythema \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Nontransient Erythema \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Telangiectasia \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1st-line therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Monotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Topical brimonidine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PDLIPLTopical brimonidine<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PDLIPL \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Combination \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Topical brimonidine <span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span> vascular laser therapy or IPL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PDL or IPL <span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span> topical brimonidine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PDL <span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span> IPL \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2nd-line therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Monotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral β-blockers (off label) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Other vascular laser therapiesOral β-blockers (off label) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Electrodesiccation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Combination \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2114499.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Symptomatic treatment.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Treatments for Erythema/Telangiectasia</p>" ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Abbreviations: IPL, intense pulsed light; IVM, ivermectin; MTZ, metronidazole; PDL, pulsed dye laser.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mild \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Moderate \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Severe \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1st-line therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Monotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Topical IVMTopical MTZ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Topical IVMTopical MTZOral doxycycline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral doxycyclineOral isotretinoin \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Combination \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IVM <span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span> oral doxycyclineMTZ <span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span> oral doxycyclinetopical IVM or MTZ <span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span> PDL or IPL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IVM <span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span> oral doxycyclineIVM <span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span> oral isotretinoinMTZ <span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span> oral doxycyclineMTZ <span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span> oral isotretinoin<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span> PDL or IPL \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2nd-line therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Monotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Azelaic acidOral doxycyclineOther oral antibioticsOther topical antibiotics<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Azelaic acidOther topical antibiotics<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>Other oral antibioticsOral isotretinoin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Other oral antibioticsOral antiparasitic agents \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Combination \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Topical IVM <span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span> topical MTZ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maintenance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Monotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Topical IVMTopical MTZAzelaic acid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Topical IVMTopical MTZAzelaic acid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Topical IVMTopical MTZAzelaic acidOral isotretinoin \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2114500.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Sulfacetamide, erythromycin clindamycin.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Treatments for Papulopustular Rosacea</p>" ] ] 4 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Abbreviations: IPL, intense pulsed light; PDL, pulsed dye laser.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Active \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Stable \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1st-line therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Monotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral doxycycline or isotretinoin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Scanned or pulsed CO<span class="elsevierStyleInf">2</span> laser therapyDermabrasionElectrosurgerySurgery \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Combination \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral doxycycline <span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span> PDL or IPLOral isotretinoin (off label) <span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span> vascular laser therapy or IPL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Combination of nonmedical therapies \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2nd-line therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Monotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Other oral antibioticsOral antiparasitic agents \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Combination \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maintenance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Monotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Topical metronidazoleTopical ivermectinAzelaic acid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Combination \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2114497.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Treatments for Phymatous Rosacea.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0030" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at6" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1st-line therapy</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Monotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Topical metronidazole \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Topical tetracycline \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral doxycycline \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Combination \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Topical metronidazole <span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span> oral doxycycline \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2nd-line therapy</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Monotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Topical ciclosporin \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Combination \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral isotretinoin \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maintenance</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Monotherapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Topical metronidazole \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Combination \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2114495.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Patients with ocular involvement should be referred to an ophthalmologist for evaluation.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Treatments for Ocular Involvement in Rosacea<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a></p>" ] ] 6 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 29733 ] ] 7 => array:5 [ "identificador" => "upi0010" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc2.pdf" "ficheroTamanyo" => 61899 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:37 [ 0 => array:3 [ "identificador" => "bib0190" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Intervenciones para la rosácea (Revisión Cochrane traducida). 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| 2021 March | 116 | 79 | 195 |
| 2021 February | 161 | 43 | 204 |
| 2021 January | 85 | 29 | 114 |
| 2020 December | 48 | 18 | 66 |
| 2020 November | 42 | 28 | 70 |
| 2020 October | 47 | 28 | 75 |
| 2020 September | 58 | 33 | 91 |
| 2020 August | 52 | 42 | 94 |
| 2020 July | 53 | 32 | 85 |
| 2020 June | 61 | 45 | 106 |
| 2020 May | 45 | 26 | 71 |
| 2020 April | 75 | 38 | 113 |
| 2020 March | 32 | 16 | 48 |
| 2020 February | 3 | 2 | 5 |
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