A recent meeting of dermatologists and ophthalmologists has made a significant change to what constitutes a diagnosis of rosacea. This change will likely reframe many discussions on how practitioners come to make a diagnosis of rosacea. Also, given the internet age and easy access for patients to disease information, these changes will also affect how sufferers of facial skin symptoms find a name to describe their condition.
Rosacea Diagnosis Previously
Since 2002 the `official’ criteria to diagnose rosacea was a schedule sponsored by the NRS. You needed to have at least one of the following primary features to achieve a diagnosis of rosacea;
- non-transient erythema,
- papules/pustules, or
The reason for a change to this list of symptoms that define rosacea has been described as;
“While the rosacea management landscape has advanced, the current subtype-based view of the disease can hinder progress by limiting the way we consider treatment options.
and the possible benefits of a new diagnosis regime are ;
These new ROSCO recommendations should help to make a positive impact on future treatment development and ultimately help improve the lives of people with rosacea through a symptom-led approach
New Rosacea Diagnosis Regime
The global panel responsible for this declaration have reached consensus on what they consider should constitute a diagnosis of rosacea – any of the 2 following features;
- persistent, centrofacial erythema associated with periodic intensification, or
- phymatous changes
So the recommendation of the panel was that a rosacea diagnosis should be considered when you have
- a) centralised redness of the face that varies with intensity, but persists and/or
- b) swelling of sebaceous glands as seen as phymatous changes
What is Phymatous Rosacea?
The new ROSCO remmendations suggest that `phymatous changes’ are on their own an indication of rosacea. So what are phymatous changes ? The term may be unfamiliar but it refers to the swelling of sebaceous glands that leads to the sorts of overgrowth of facial tissue seen in rhinophyma.
So what has changed?
The difference between the 2 schedules is that now flushing, papules/pustules and telangiectasia on their own are not enough to be diagnosed with rosacea. A red face or or sebaceous / phymatous swelling is now key.
It isn’t clear to me how this altered definition of a diagnosis of rosacea will naturally lead to improvements due to now being part of a `symptom-lead’ approach, but I’m willing to see how doctors and patients see things in a new light now.
Rosacea Diagnostic Schedule
(>= 75% consensus)
(>= 50% agreement)
(>= 75% consensus)
|Persistent centrofacial erythema associated with periodic intensification by potential trigger factors||Flushing/ transient erythema||Burning sensation of the skin|
|Phymatous changes||Inflammatory papules and pustules||Stinging sensation of the skin|
|Ocular manifestations - lid margin telangiectasia, blepharitis, keratitis/ conjuctivitis/ sclerokeratitis||Dry sensation of the skin|
The publication of this new diagnosis guide had been accompanied by a press release highlighting the
- Expert insights reveal need for shift in current rosacea management to a symptom-led approach and provide new guidance as a catalyst for change
- Consensus panel experts share vision for rosacea patients to be treated according to their specific signs and symptoms (known as phenotypes), leading to individualised rosacea therapy
- ROSCO rosacea algorithm sets out new approach to appropriate individualised treatment
LONDON–(BUSINESS WIRE)–International recommendations that aim to transition current rosacea classification, diagnosis and treatment from subtypes to a phenotype approach, based on signs and symptoms of rosacea, have been published in the British Journal of Dermatology.1,2 These recommendations address a need to improve outcomes for patients with rosacea through better identification and personalised treatment of signs and symptoms that bother each patient most.
J. Tan, L. Almeida, A. Bewley, B. Cribier, N. Dlova, R. Gallo, G. Kautz, M. Mannis, H.
Oon, M. Rajagopalan, M. Steinhoff, D. Thiboutot, P. Troielli, G. Webster, Y. Wu,
E. van Zuuren, M. Schaller
Br J Dermatol. 2016 Oct 8
Rosacea is currently diagnosed by consensus-defined primary and secondary features and managed by subtype. However, individual features (phenotypes) can span multiple subtypes, which has implications for clinical practice and research. Adopting a phenotype-led approach may facilitate patient-centred management.
OBJECTIVES: To advance clinical practice by obtaining international consensus to establish a phenotype-led rosacea diagnosis and classification scheme with global representation.
METHODS: Seventeen dermatologists and three ophthalmologists used a modified Delphi approach to reach consensus on statements pertaining to critical aspects of rosacea diagnosis, classification and severity evaluation. All voting was electronic and blinded.
RESULTS: Consensus was achieved for transitioning to a phenotype-based approach to rosacea diagnosis and classification. Two features were independently considered diagnostic for rosacea: persistent, centrofacial erythema associated with periodic intensification; and phymatous changes. Flushing, telangiectasia, inflammatory lesions and ocular manifestations were not considered individually diagnostic. The panel reached agreement on dimensions for phenotype severity measures and established the importance of assessing the patient burden of rosacea.
CONCLUSIONS: The panel recommended an approach for diagnosis and classification of rosacea based on disease phenotype.