Do I have Rosacea? – Questionnaire to answer definitively yes or no

A very interesting paper has just been published that details a new questionnaire and `screening algorithm’ that has achieved a very high success in diagnosing rosacea.

Currently there is no generally recognised way to screen people as either suffering from rosacea or not. This newly proposed screening instrument looks to be a convenient way to determine clearly the true prevalence of rosacea in the community.

How many people have Rosacea?

The National Rosacea Society tells us that rosacea is “estimated to affect well over 16 million Americans” and the NHS figure is “about 14 million”, but beyond this guess work, little hard data exists proving the true prevalence of rosacea.

Additionally a universally available and executable diagnostic instrument would aid in the rapid diagnosis of rosacea and help in directing sufferers to the most applicable treatment.

What is the Questionnaire & Algorithm?

Rosacea was defined as present on screening if at least 1 of the following was positive: rhinophyma, central facial persistent erythema, facial warmth or stinging/burning for darker phototypes (IV to VI), and/or previous diagnosis of rosacea.

Here is a example of the questions relating to persistent facial erythema, telangiectasia and ocular manifestations.

(click for a larger view)

Here is an example of the question relating to facial warmth and/or stinging/burning sensation, rhinophyma and papules and pustules.

(click for a larger view)

What is Sensitivity and Specificity

Sensitivity, or the proportion of subjects with rosacea, shows the ability of the test to identify true rosacea patients and was targeted to approach 100%.

Specificity is the ability of the test to identify patients without rosacea.

The paper tells us that he questionnaire was developed with the aim of achieving the highest sensitivity (primary objective) based on subject comprehension.

The final version of the questionnaire had a sensitivity of 93% to 100% for key diagnostic criteria. The algorithm had a sensitivity of 100% for detection of rosacea and specificity of 63% to 71%.

This means that together the questionnaire and algorithm have a very accurate ability to answer the question – do I have rosacea?

Papules and Pustules Excluded

The paper tells us that the creators decided to exclude the symptoms of papules and pustules and ocular manifestations as they are highly prevalent in other conditions like acne vulgaris and allergic conjuctivitis, and their inclusion would have reduced the ability of the instrument to declare subjects without rosacea.

This leaves we wondering how the well the system will diagnose those rosacea sufferers who are only aware of their papules and pustules. Some erythema will presumably be required to be present as well in order to confirm a diagnosis.

The Full Questionnaire?

As you can see several of the paper’s authors belong to companies selling products that treat rosacea, so you could imagine that the questionnaire might well become a commercial product. If I am able to access a copy of the full product I will post it here.

[Update]

The full PDF of the paper is available here – Development and Evaluation of a Rosacea Screening Instrument (Rosascreen).

Abstract

Development and Evaluation of a Rosacea Screening Instrument (Rosascreen).
J Cutan Med Surg. 2016 Feb 1;
Authors:
Tan J. – University of Western Ontario, London, Ontario Windsor Clinical Research Inc, Windsor, Ontario, Canada.
Leyden J. – KGL Inc, Broomall, Pennsylvania, USA.
Cribier B. – Clinique Dermatologique, Hôpitaux Universitaires, Strasbourg, France.
Audibert F., Kerrouche N. – Galderma R&D SNC, Sophia Antipolis, France.
Berg M. – University of Uppsala, Uppsala, Sweden.
BACKGROUND: There are no current instruments to facilitate population screening for rosacea.
OBJECTIVE: To develop and evaluate a screening instrument for rosacea applicable for population surveys.
METHODS: A rosacea-specific screening instrument (Rosascreen), consisting of a subject-completed questionnaire and screening algorithm, was developed based on current diagnostic criteria for rosacea. Three iterations were pilot tested and refined for clarity and sensitivity in adult outpatients with and without rosacea.
RESULTS: Three subject groups were consecutively evaluated with iterations of the questionnaire at each centre (overall N = 121). The final version had a sensitivity of 93% to 100% for key diagnostic criteria, and use of the algorithm had a sensitivity of 100% for detection of rosacea and specificity of 63% to 71%. Most subjects found the questionnaire easy to understand and complete.
CONCLUSION: Rosascreen, a subject-completed questionnaire and diagnostic algorithm, is a highly sensitive screening instrument that may facilitate estimation of rosacea prevalence in general populations.