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Enzo Berardesca,1 Adriana Bonfigli,2 Bernard Cribier,3 Frederic Flament,4 Marco Vicic,4 Delphine Kerob,5 Jerry Tan6 1Phillip Frost Department of Dermatology, University of Miami, Miami, FL, USA; 2ISPE, Milano, Italy; 3Clinique Dermatologique, University Hospital, Strasbourg, France; 4L’Oréal Research and Innovation, Chevilly-Larue, France; 5Laboratoires Vichy International, Levallois-Perret, France; 6Western University, Department of Medicine and Windsor Clinical Research Inc, Windsor, ON, CanadaCorrespondence: Enzo BerardescaPhillip Frost Department of Dermatology, University of Miami, Miami, FL, USATel +1 393486962500Email berardesca@berardesca.itObjective: This study assessed the efficacy and tolerability of M89 in patients with rosacea associated with erythema and sensitive skin.Methods: Intra-individual study in a split-face design comparing after 30 days M89 twice daily and usual skin care in 20 adult subjects with rosacea and sensitive skin. M89 contains 89% Vichy volcanic mineralizing water (VVMW) and 0.4% hyaluronic acid. It is hypoallergenic and contains no perfume and this convenes in rosacea. Contained minerals reinforce the natural defences of the skin in restoring the natural skin barrier, stimulating antioxidant activity and reducing inflammation, commonly observed in subjects with rosacea. Clinical evaluations included assessment of erythema, desquamation, papules and pustules, skin tightness, dryness, burning sensation, itching, stinging and stinging test as well as local tolerability. Instrumental evaluations included skin hydration and TEWL. Subject satisfaction was assessed at Days 15 and 30. Demodex density was assessed at Day 30.Results: A significant superiority of M89 over the standard skin care was observed for erythema, skin tightness and dryness (all P≤ 0.05) as early as Day 15, the skin stinging test was significantly in favour of M89 (P< 0.05 at Day 15 and P< 0.01 at Day 30) and for skin hydration (P< 0.0001) at Day 15 and 30 with no difference in mean Demodex density between M89 and usual skin care after 30 days. Tolerance was excellent and subject satisfaction very high.Conclusion: Study results concerning M89 are encouraging for its use either alone or as an adjuvant daily skin care to topical medication in patients with persistent centrofacial erythema of rosacea with no more than 3 papules and pustules.Keywords: rosacea, sensitive skin, Vichy volcanic mineralizing water, M89, split face

BackgroundA transition from a subtyping to a phenotyping approach in rosacea is underway, allowing individual patient management according to presenting features instead of categorization by predefined subtypes. The ROSacea COnsensus (ROSCO) 2017 recommendations further support this transition and align with guidance from other working groups.ObjectivesTo update and extend previous global ROSCO recommendations in line with the latest research and continue supporting uptake of the phenotype approach in rosacea through clinical tool development.MethodsNineteen dermatologists and two ophthalmologists used a modified Delphi approach to reach consensus on statements pertaining to critical aspects of rosacea diagnosis, classification and management. Voting was electronic and blinded.ResultsDelphi statements on which the panel achieved consensus of ≥ 75% voting 'Agree' or 'Strongly agree' are presented. The panel recommends discussing disease burden with patients during consultations, using four questions to assist conversations. The primary treatment objective should be achievement of complete clearance, owing to previously established clinical benefits for patients. Cutaneous and ocular features are defined. Treatments have been reassessed in line with recent evidence and the prior treatment algorithm updated. Combination therapy is recommended to benefit patients with multiple features. Ongoing monitoring and dialogue should take place between physician and patients, covering defined factors to maximize outcomes. A prototype clinical tool (Rosacea Tracker) and patient case studies have been developed from consensus statements.ConclusionsThe current survey updates previous recommendations as a basis for local guideline development and provides clinical tools to facilitate a phenotype approach in practice and improve rosacea patient management. What's already known about this topic? A transition to a phenotype approach in rosacea is underway and is being recommended by multiple working groups. New research has become available since the previous ROSCO consensus, necessitating an update and extension of recommendations. What does this study add? We offer updated global recommendations for clinical practice that account for recent research, to continue supporting the transition to a phenotype approach in rosacea. We present prototype clinical tools to facilitate use of the phenotype approach in practice and improve management of patients with rosacea.