Clinical Evaluation of 168 Korean Patients with Rosacea: The Sun Exposure Correlates with the Erythematotelangiectatic Subtype

Abstract

Background:Although rosacea is a chronic cutaneous inflammatory disorder that's commonly seen in adults, the etiology and pathogenesis of the illness remain unclear. A well established diagnostic classification and grading system may play a critical role in performing research and it would serve as a diagnostic reference in the clinical field. Objective: We sought to classify the patients with the new standard classification and grading system and we wanted determine the peculiar features and relationships of each subtype. We also analyzed the relationships between the degree of sun exposure and each subtype. Methods: We reviewed the medical records and clinical photos of 168 patients who were diagnosed with rosacea from 2002 to 2007 at our hospital. The standard classification and grading system suggested by the National Rosacea Society (NRS) Expert Committee was adopted to evaluate each patient's subtype and the severity. Results: The male：female ratio was 1： 2.29. The mean age at the time of diagnosis was 47.8 years. The mean duration of disease was 3.5 years. Sun exposure and hot baths/exercise were the two most common precipitating factors, while the majority of patients did not have any specific factor that relieved their symptoms. According to the NRS classification and grading system, the patients were classified into four subtypes. One hundred sixty two (96.4%) patients were diagnosed with the erythematotelangiectatic subtype irrespective of severity.Eighty five (50.6%) patients had the papulopustular subtype and 24 (14.3%) patients had ocular rosacea. Eight (4.8%) patients displayed mild phymatous change. The degree of sun exposure had significant correlation with the development and severity of the erythematotelangiectatic subtype (p<0.05), while it had no correlation with the papulopustular, ocular and phymatous subtypes. Conclusion: Although the erythematotelangiectatic subtype was the most common subtype of rosacea, many patients also had other subtypes of rosacea simultaneously. Based on our results, we proved that ocular rosacea is an extension of the clinical spectrum of erythematotelangiectatic rosacea. In addition, the results of our study particularly suggest that sun exposure has a different influence on each subtype of rosacea. (Ann Dermatol 21(3) 243∼249, 2009)

An observational cross-sectional survey of rosacea: clinical associations and progression between subtypes

“…A previous study involving 168 subjects with rosacea found a significant association between the severity of ETR and OC, but no association between PPR and PHY. 15 However, in that study only seven (4Á2%) subjects had phymatous features, compared with 33 (24%) in the present survey. A recent review of rosacea indicates that flushing associated with this condition is not evanescent but prolonged and can persist for longer than 10 min.…”

“…These findings concur with previous studies showing that persistent erythema was the most common of the four primary features. 15 We also observed that erythema was universally reported as the most bothersome feature of rosacea.…”

“…The predominance of ETR over PPR and of female sex, and the peak age range distribution in this study concur with results of previous investigations in subjects with lighter phototypes. 13,15,18 However, studies in subjects with darker phototypes 16,17 revealed a predominance of PPR. This disparity may be due to the intrinsic difficulty in visually detecting erythema in dark skin.…”

“…The prevalence of ocular symptoms in 36% of this cohort is within the range of previous recent investigations from dermatology clinics. 15,22,23 However, case-finding for OC is nonspecific with a broad spectrum of ocular signs and symptoms. Improving diagnostic accuracy will require determination of signs/symptoms specific for ocular rosacea.…”

Clinical Evaluation of 368 Patients with Nasal Rosacea: Subtype Classification and Grading of Nasal Rosacea

“…Previous studies have evaluated clinical differences and progression between rosacea subtypes [15,17]. A small proportion of subjects with ETR may progress to PPR and to PHY, whereas a small proportion of those with PPR may develop PHY.…”