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  • The RRDi endorsed the phenotype classification of rosacea in November 2016.  Galderma acknowledged the phenotype classification about a year later. In November 2017 the NRS has now moved forward with classifying rosacea into phenotypes with its own published paper. [1] Read about phenotype updates of medical authorities and rosacea organizations that have recognized this superior classification of rosacea

    For over fourteen years, rosacea was classified as subtypes, which has been controversial from the beginning. A new direction has emerged in the diagnosis and classification of rosacea which is superior to the subtype classification because the phenotype uses a "a symptom-oriented therapy approach."  

    "Because rosacea can encompass a multitude of possible combinations of signs and symptoms, the following updated classification system is based on phenotypes—observable characteristics that can result from genetic and/or environmental influences—to provide the necessary means of assessing and treating rosacea in a manner that is consistent with each individual patient's experience. The phenotypes and diagnostic criteria are largely in agreement with those recommended by the global rosacea consensus panel in 2016, and at least 1 diagnostic or 2 major phenotypes are required for the diagnosis of rosacea.' [1]

    For more information read the article by the ROSCO panel: 

    ROSCO Panel Recommends New Approach on Rosacea Diagnosis by Phenotype

    Phenotype Questions

    Phenotype Classification - How does it work? Answer.

    Why is the phenotype classification superior to the subtype classification?  Answer

    What distinguishes the phenotype classification from the subtype classification? Answer.

    Applying the Phenotype Approach for Rosacea to Practice and Research

    In the British Journal of Dermatology, May 25, 2018, it states, “Rosacea diagnosis and classification have evolved since the 2002 National Rosacea Society (NRS) expert panel subtype approach. Several working groups are now aligned to a more patient-centric phenotype approach, based on an individual's presenting signs and symptoms. However, subtyping is still commonplace across the field and an integrated approach is required to ensure widespread progression to the phenotype approach." [2]

    ”These practical recommendations are intended to indicate the next steps in the progression from subtyping to a phenotyping approach in rosacea, with the goals of improving our understanding of the disease, facilitating treatment developments, and ultimately improving care for patients with rosacea.” [2]

    "In conclusion, the updated phenotype approach, based on presenting clinical features, is the foundation for current diagnosis, classification, and treatment of rosacea." [3]

    Subtype Classification Inferior to Phenotype Classification
    "Almost a decade and a half has elapsed since the initial proposition of criteria for rosacea diagnosis and grouping into common presentations or subtypes. Reappraisal of these items suggests shortcomings in case-finding and diagnostic accuracy that require revision to facilitate rather than undermine future investigation. Subtyping of rosacea, a post-hoc means of grouping more common presentations, can be and has been subverted inappropriately to imply strict categories without adequate consideration of the varying phenotypic presentation of individuals and the potential for temporal variation. Scales for rosacea severity are also confounded by similar multidimensional aspects represented in subtyping. In clinical investigation, this can interfere with study of the course of singular features of rosacea and their measurement." [4]

    End Notes
    [1] Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee

    [2] Applying the phenotype approach for rosacea to practice and research.
    Br J Dermatol. 2018 May 25;
    Tan J, Berg M, Gallo RL, Del Rosso JQ

    [3] Skin Therapy Lett. 2021 Jul;26(4):1-8.
    Rosacea: An Update in Diagnosis, Classification and Management
    Cindy Na-Young Kang, Monica Shah, Jerry Tan

    [4]  Shortcomings in rosacea diagnosis and classification



  • Posts

    • "Rosacea is a common inflammatory skin disorder mediated by the dysregulation of both keratinocytes and T cells. Here, we report that aquaporin 3 (AQP3), a channel protein that mediates the transport of water/glycerol, was highly expressed in the epidermis and CD4+ T cells of both rosacea patients and experimental mice....Our findings reveal that AQP3-mediated activation of NF-κB in keratinocytes and activation of STAT3 in CD4+ T cells acted synergistically and contributed to the inflammation in rosacea." [1] "Aquaporin 3 (AQP-3) is the protein product of the human AQP3 gene." [2] "Aquaporins (AQPs) are water channels that facilitate transepithelial water transport across plasma membranes following an osmotic gradient [3]. AQPs are glycosylated integral membrane proteins and widely expressed in bacteria (for review [4]), yeast [5], plants [6] (for review [7]), and mammals..." [3] Obviously we need more rosacea research on this subject. Do you want to support such targeted research? Join the RRDi and post in this thread. A Graphical abstract of AQP3 [4] End Notes [1] PubMed RSS Feed - -Targeting Aquaporin-3 Attenuates Skin Inflammation in Rosacea  [2] Aquaporin-3, Wikipedia [3] Aquaporin-3 in Cancer Saw Marlar, Helene H. Jensen, Frédéric H. Login, and Lene N. Nejsum Int J Mol Sci. 2017 Oct; 18(10): 2106. Published online 2017 Oct 7. doi: 10.3390/ijms18102106 [4] Biochimica et Biophysica Acta (BBA) - Biomembranes Volume 1861, Issue 4, 1 April 2019, Pages 768-775 Single-channel permeability and glycerol affinity of human aquaglyceroporin AQP3 Roberto A. Rodriguez, Huiyun Liang, Liao Y. Chen, Germán Plascencia-Villa, George Perry 
    • "In fact, rosacea might be underreported and underdiagnosed in populations with skin of color because of the difficulty of discerning erythema and telangiectasia in dark skin. The susceptibility of persons with highly pigmented skin to dermatologic conditions like rosacea, whose triggers include sun exposure, is probably underestimated. Many people with skin of color who have rosacea might experience delayed diagnosis, leading to inappropriate or inadequate treatment; greater morbidity; and uncontrolled, progressive disease with disfiguring manifestations, including phymatous rosacea." Global epidemiology and clinical spectrum of rosacea, highlighting skin of color: Review and clinical practice experience Andrew F. Alexis MD, MPH, Valerie D. Callender MD, Hilary E. Baldwin MD, Seemal R. Desai MD, Marta I. Rendon MD, Susan C. Taylor MD  Journal of the American Academy of Dermatology Volume 80, Issue 6, June 2019, Pages 1722-1729.e7
    • In  2004, it has been stated that "The economic burden of skin disease on the US healthcare was approximately $96 billion in 2004. [1] "In 2013, more than 85 million Americans were seen by a medical professional for skin diseases. The United States healthcare system alone is estimated to spend approximately 75 billion dollars annually to treat skin diseases. Additionally, the prevalence of skin disease increases to almost 50% in Americans 65 years of age or older). Moreover, it is estimated that the population over the age of 65 will almost double in the United States in the next 30 years, leading to an inevitable increase in annual healthcare costs for skin disease treatment." [2] This expenditure is on all skin conditions. A "Data Bridge Market Research analyses that the rosacea treatment market, which was USD 1.8 billion in 2022, would rocket up to USD 2.6 billion by 2030 and is expected to undergo a CAGR of 6.1% during the forecast period of 2023 to 2030." - Global Rosacea Treatment Market, DBMR  How much is spent on rosacea in the USA?  Rosacea How many of those billions are spent on rosacea? As the above figures shows it is in the millions of dollars.  "In 2013, the costs associated with the treatment and lost productivity among those who sought medical care for rosacea was $243 million." [2] Between 2002 and 2005, for an individual patient, "Of the total healthcare costs, annual rosacea-related expenditures were $276; approximately 70% of rosacea-related expenditures were due to prescription drugs. [3]  In 2013, "The treatment of rosacea incurred primarily pharmacy rather than medical costs. The median annual pharmacy costs, by type of therapy, were: $285 for combination therapy $142 for a topical medication $63 for an oral antibiotic agent." [4] In 2014, the NRS states, "The lack of health insurance or the amount of the required co-pay kept 47 percent of the survey respondents from obtaining medical care for their rosacea at some point.  And 56 percent reported they had paid out-of-pocket for a rosacea-related medication or procedure not covered by their insurance policy.  Of those answering the survey, the amount paid out of pocket was less than $100 for 33 percent, between $100 and $500 for 35 percent, between $500 and $1,000 for 12 percent and greater than $1,000 for 11 percent." [6] End Notes [1] Bickers DR, Lim HW, Margolis D, et al; for the American Academy of Dermatology Association, and the Society for Investigative Dermatology. The burden of skin diseases: 2004 a joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology. J Am Acad Dermatol. 2006;55: 490-500. [2] Aquaporin-3 in the epidermis: more than skin deep Wendy B. Bollag, Lorry Aitkens, Joseph White, and Kelly A. Hyndman Am J Physiol Cell Physiol. 2020 Jun 1; 318(6): C1144–C1153. Published online 2020 Apr 8. doi: 10.1152/ajpcell.00075.2020 [3] SKIN CONDITIONS BY THE NUMBERS, AAD [4] Healthcare utilization and costs of patients with rosacea in an insured population Michael Romanowicz, Judith J Stephenson, James Q Del Rosso, Greg Lenhart Dermatol. 2008 Jan;7(1):41-9. Healthcare utilization and costs of patients with rosacea in an insured population [5] Cost and Drug Utilization Patterns Associated with the Management of Rosacea Caroline Helwick, Medical Writer Am Health Drug Benefits. 2013 Nov-Dec; 6(9): 583–584. [6] New Survey Shows Insurance Covers Medication For Most, NRS
    • Int J Dermatol. 2023 Nov 29. doi: 10.1111/ijd.16950. Online ahead of print. NO ABSTRACT PMID:38031285 | DOI:10.1111/ijd.16950 {url} = URL to article
    • PubMed RSS Feed - -Successful Treatment of Granulomatous Rosacea by JAK Inhibitor Abrocitinib: A Case Report If you are taking vandetanib read this:  PubMed RSS Feed - -Dark perifollicular macules and granulomatous rosacea secondary to vandetanib
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