You may have missed it, but the new way to diagnose rosacea is based on phenotypes. Yes, we no longer talk about rosacea sub-types but refer to the phenotypes of rosacea.
Here is everything you need to know about this new way of describing rosacea symptoms.
Lets start with a graphic that shows at a high level what we are talking about – the diagnostic features, the major features and minor features of rosacea. What does this mean? Well put simply – how do we now officially diagnose rosacea, and once diagnosed, what are the major and minor features?
Do you know the phenotypes present in #rosacea? #dermatology #EADV pic.twitter.com/LTem7DCm2H
— Galderma (@galderma) September 15, 2017
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;
- flushing,
- non-transient erythema,
- papules/pustules, or
- telangiectasia
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
Diagnostic Features
Persistent centrofacial erythema associated with periodic intensification by potential trigger factors.
The major features of this is redness of the skin, which can flare-up when exposed to trigger factors.
Phymatous Changes
The major features of these are papules and pustules, dilate blood vessels, and problems affecting the eyes.
Major Features
- Flushing/Transient centrofacial erythema.
- Inflammatory lesions
- Telangiectasia
- Ocular Manifestations
Minor Features
- Burning sensation
- Stinging sensation
- Oedema
- Dry skin
More comments from the National Rosacea Society
The NRS has provided some more commentary on why they consider this a significant update for rosacea diagnosis and treatment
What the New Classification System Update Means for Rosacea Patients
… the updated classification system, which introduces a new approach to diagnosing rosacea based on individual signs and symptoms. While the original classification system described the most common groupings of signs and symptoms as subtypes, the consensus committee noted that diagnosis should now focus on the individual characteristics that may result from what is now understood as the same disease process. By doing so, they emphasized, the full range of potential signs and symptoms may be taken into consideration.
According to the new system, a diagnosis of rosacea may be considered in the presence of at least one diagnostic sign — either persistent redness of the central facial skin or, less commonly, thickened skin in the central face (known as phymatous changes, often on the nose).
Two or more major signs, including bumps and pimples, flushing, visible blood vessels and eye irritation, may also indicate rosacea. Secondary signs and symptoms, such as burning or stinging, swelling and dry appearance, may also develop but are not diagnostic.
Physicians must rule out other possible causes of rosacea-like symptoms — such as lupus, steroid-induced rosacea or seborrheic dermatitis — before confirming the diagnosis.
As Rosacea News comment in How to diagnose Rosacea has radically changed;
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.
