Jump to content
  • 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

    • Skin Appendage Disord. 2022 Nov;8(6):462-468. doi: 10.1159/000525024. Epub 2022 Jun 7. ABSTRACT INTRODUCTION: The present study aimed to obtain fundamental data, including climate conditions and Demodex mites, on rosacea and similar diseases in the situation where the wearing of face masks is mandatory due to the coronavirus disease 2019 pandemic. METHODS: We enrolled 86 Japanese patients habitually wearing face masks with rosacea and similar diseases. Disease severity was assessed using the Investigator Global Assessment. The presence of Demodex mites was examined microscopically. Treatment involved acaricidal and antibiotic agents. RESULTS: The numbers of male and female patients enrolled were 11 and 75, respectively. Among these patients, 85 (98.8%), 57 (66.3%), and 76 (88.4%) had rosacea, rosacea-like dermatitis (RLD), and demodicosis, respectively. The monthly number of patients with rosacea and demodicosis showed two peaks from May to June and in October, during which monthly mean temperature was approximately 20°C (68°F). Improvement rates in rosacea, RLD, and demodicosis were significantly higher when Demodex mites were no longer detected after treatment. CONCLUSION: The present results suggest that a season with a mean temperature of approximately 20°C is a risk factor for rosacea and similar diseases in individuals wearing face masks in Japan, and a decrease in Demodex mites is associated with the attenuation of symptoms. PMID:36407649 | PMC:PMC9672874 | DOI:10.1159/000525024 {url} = URL to article
    • J Cosmet Laser Ther. 2022 Nov 17:1-6. doi: 10.1080/14764172.2022.2147953. Online ahead of print. ABSTRACT A chemical peel is chemexfoliation, a process of application of a chemical substance to the skin that causes controlled chemical destruction of the epidermis with or without part of the dermis leading to skin regeneration and remodeling. It can be classified depending upon the depth of penetration into superficial, medium, and deep peels. Among various indications, peels can be used to enhance treatment within a variety of conditions including skin- rejuvenation, inflammatory disorders like acne, rosacea, acne scar, and pigmentary disorders like melasma, freckles, lentigens, dyschromia, and post-inflammatory pigmentation. We did a chemical peel for six patients with facial melanosis, diagnosed with Riehl melanosis. All patients had visible clinical improvement. Detailed history and informed consent were taken both for photographs and procedures from all patients. PMID:36384385 | DOI:10.1080/14764172.2022.2147953 {url} = URL to article
    • J Clin Aesthet Dermatol. 2022 Nov;15(11):69-74. ABSTRACT OBJECTIVE: Subantibiotic dose doxycycline (SDD40), formulated as a modified-release 40mg capsule administered once daily, is used to treat inflammatory lesions of rosacea. In order to investigate whether the patient's weight or lesion severity impacts clinical outcomes with using SDD40, the efficacy and safety of SDD40 in treating rosacea were evaluated in randomized controlled studies (RCTs). METHODS: Phase II, III, and IV RCTs, and a subsequent meta-analysis were described. For all studies, the primary efficacy endpoint was the change in total inflammatory lesion count (papules, pustules, and nodules) from baseline to Week 16. For one of the studies, body weights were categorized by BMI (body mass index). Secondary efficacy endpoints included the change in Investigator's Global Assessment (IGA). Safety was assessed by monitoring adverse events (AEs). RESULTS: The efficacy of SDD40 was consistent across the studies (two trials including n=72 and n=91 subjects) and meta-analysis (n=127 and n=142). SDD40 remained effective regardless of baseline disease severity and weight (with a weak correlation coefficient below 0.75); overweight or obese subjects with severe rosacea cleared at least as well if not better than those with a normal BMI and mild disease. The treatment was well tolerated with no to minimal gastrointestinal-related AEs. LIMITATIONS: Retrospective analyses have methodological limitations. CONCLUSION: Consistency between study results including the meta-analysis supports the effectiveness and safety of SDD40, irrespective of the weight of the patient or rosacea severity based on inflammatory lesion count at baseline. PMID:36381182 | PMC:PMC9651154 {url} = URL to article
    • Transl Vis Sci Technol. 2022 Nov 1;11(11):13. doi: 10.1167/tvst.11.11.13. ABSTRACT PURPOSE: Dry eye disease (DED) is a heterogeneous condition with poorly characterized subtypes. The DREAM study was a large multicenter randomized clinical trial that did not find omega-3 to be more effective than placebo in treating symptomatic DED. We performed secondary analysis of DREAM data to characterize DED subtypes and their omega-3 response. METHODS: A total of 535 patients with moderate-to-severe DED were randomized to omega-3 or placebo treatment for one year. We used latent profile analysis to identify subtypes based on baseline Ocular Surface Disease Index, tear break-up time (TBUT), anesthetized Schirmer's test, corneal and conjunctival staining, and meibomian gland dysfunction (MGD). We evaluated omega-3's effect for each subtype using generalized linear regression. RESULTS: Five clinically meaningful DED subtypes were identified. They differed significantly in sex (P < 0.001) and race (P = 0.02). Subtype 1 had the most severe DED signs yet milder symptoms and was associated with more Sjögren's syndrome (21%, P < 0.001). Subtype 2 had the mildest DED signs except MGD. Subtype 3 had the most severe symptoms, out of proportion to DED signs. Subtype 4 had relatively milder symptoms and MGD. Subtype 5 had severe MGD and TBUT and was associated with rosacea (29%, P = 0.04). Omega-3 was not significantly more beneficial than placebo for any subtype. CONCLUSIONS: Five clinically meaningful DED subtypes differed significantly in demographics, symptoms, signs, and systemic disease associations. Omega-3 was not significantly more effective than placebo for any subtype. TRANSLATIONAL RELEVANCE: T3 translational research identifying subtypes in the DREAM study can improve DED clinical classification and targeted management. PMID:36383391 | DOI:10.1167/tvst.11.11.13 {url} = URL to article
    • We do have a few active members now who have subscribed. We need about 100 members who subscribe to keep this website going which means keeping the RRDi going. Why we chose the subscription vs the freemium version of using our website is explained here. The active members still do not post which is not a requirement, the only requirement is to subscribe. Do you have any comment and wish to post about any of this? You can post for a minimum of a two dollar subscription or if you just donate two dollars we can make you an active member for one month so you can post for a month. You simply donate through a multitude of services listed on our donation page and then CONTACT us explaining you made a minimum two dollar donation and we can activate your membership for a month (or longer if you donate more). If you don't like subscriptions, why not post and explain how we should be operating our website. Your comment could be published in this thread, ACTIVE MEMBERS POSTING, or anywhere you want to post on our website. Maybe you have some insight into why our ACTIVE members don't post at all? Even if you are a volunteer and don't post you become inactive. Read more. 
×
×
  • Create New...

Important Information

Terms of Use