Updating the diagnosis, classification and assessment of rosacea: recommendations from the global ROS acea CO nsensus ( ROSCO ) panel

Abstract

SummaryBackground 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. The following two features were independently considered diagnostic for rosacea: (i) persistent, centrofacial erythema associated with periodic intensification; and (ii) phymatous changes. Flushing, telangiectasia, inflammatory lesions and ocular manifestations were not considered to be 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.

Treatment of rosacea and demodicosis with benzyl benzoate: effects of different doses on Demodex density and clinical symptoms

“…1,2 Although still controversial, [3][4][5] evidence supporting a role of Demodex in papulopustular rosacea (PPR) is accumulating, [6][7][8][9][10] and recent guidelines for the treatment of rosacea include use of ivermectin, an acaricidal drug, as a first-line topical treatment for PPR. 1,2 Although still controversial, [3][4][5] evidence supporting a role of Demodex in papulopustular rosacea (PPR) is accumulating, [6][7][8][9][10] and recent guidelines for the treatment of rosacea include use of ivermectin, an acaricidal drug, as a first-line topical treatment for PPR.…”

Papulopustular rosacea and rosacea‐like demodicosis: two phenotypes of the same disease?

“…The National Rosacea Society (NRS) expert committee defines rosacea as a central face distribution of at least one of four primary features: flushing, persistent erythema, papules and pustules and telangiectasia . The global ROSacea COnsensus (ROSCO) panel recently suggested a more phenotype‐based approach with two features only–phymatous changes and persistent centrofacial erythema–considered as diagnostic, and other features considered as major (flushing, inflammatory papules and pustules, telangiectasia, ocular manifestations) or secondary (burning, stinging and dry sensation of the skin, oedema) …”

“…Currently, most experts distinguish two separate entities: ‘PPR, not caused by Demodex’ and ‘rosacea‐like demodicosis, caused by Demodex’ . Paradoxically, the central role of Demodex in demodicosis is generally well‐accepted, although there are no more data to support its role in demodicosis than there are to support its role in PPR.…”

Pflegeempfehlungen für die Basistherapie bei Rosazea

“…Da diese Symptome bei allen Schweregraden auftreten können und somit jeder Patient einen anderen Phänotyp zeigt und da sich Therapieoptionen an Symptomen orientieren, empfehlen Experten heute eine symptomorientierte Einteilung und Bewertung der Rosazea. Therapieoptionen umfassen folglich je nach Symptom pharmakologische, topische und systemische Maßnahmen, wie Brimonidin, Ivermectin, Azelainsäure und Doxycyclin, sowie physikalische Maßnahmen, wie Laser und Intense Pulsed Light (IPL) [2,3]. Zusätzlich gibt es allgemeine Empfehlungen, die für alle Rosazeapatienten gelten, wie das Meiden von Auslösern sowie die konsequente Anwendung von Sonnenschutz, sanften Reinigungsprodukten und Dermatokosmetika.…”