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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

    • Rev Assoc Med Bras (1992). 2023 May 29;69(6):e20230256. doi: 10.1590/1806-9282.20230256. eCollection 2023. ABSTRACT OBJECTIVE: We aimed to detect the frequency of fibromyalgia syndrome in patients with rosacea and determine whether this frequency was affected by the severity of rosacea and the quality of life. METHODS: In this prospective, controlled, cross-sectional study, a total of 94 consecutive rosacea cases and 87 age- and sex-matched controls were enrolled. The severity of rosacea was assessed in light of the findings of the National Rosacea Society Ethics Committee. Dermatology Life Quality Index and Rosacea-specific Quality-of-Life instrument had been applied to the cases of rosacea. The diagnosis of fibromyalgia syndrome was established according to the 2016 revised fibromyalgia diagnostic criteria, and the Fibromyalgia Impact Questionnaire was used to determine the functional disability. RESULTS: The frequency of fibromyalgia syndrome was higher in the rosacea group than in the control group (p=0.01), and Dermatology Life Quality Index and Rosacea-specific Quality-of-Life instrument were higher in patients with rosacea with fibromyalgia syndrome (p=0.006 and p=0.004, respectively). A statistically significant weak positive correlation was observed between Dermatology Quality-of-Life Index, Rosacea-specific Quality-of-Life instrument, and Fibromyalgia Impact Questionnaire; symptom severity scale scores; and fibromyalgia score (r=0.35, r=0.259, and r=0.32 and r=0.376, r=0.305, and r=0.312, respectively). CONCLUSION: The patients with rosacea have higher rates and disability scores of fibromyalgia syndrome than healthy controls, independent of rosacea severity, and quality of life is correlated with fibromyalgia scores. We might point out that fibromyalgia syndrome accompanying rosacea has more restrictions in their daily routine activities than rosacea alone. As such, physicians should be aware of the possible coexistence of rosacea and fibromyalgia syndrome. PMID:37255090 | DOI:10.1590/1806-9282.20230256 {url} = URL to article
    • Front Pharmacol. 2023 May 11;14:1169916. doi: 10.3389/fphar.2023.1169916. eCollection 2023. ABSTRACT Background: Antibiotics are considered the backbone of rosacea management, especially for controlling inflammatory papules and pustules. We aim to evaluate the efficacy and safety of varied prescriptions and doses of antibiotics in treating rosacea by network meta-analysis. Methods: In this study, we compared all available randomized controlled trials (RCTs) that have studied systemic and topical antibiotics and placebo in rosacea therapy. We searched databases such as the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PubMed, Web of Science, and LILACS for published and unpublished RCTs on ClinicalTrials.gov before April 2023. The primary outcome was the improvement of the Investigator's Global Assessment (IGA) scores, and the secondary outcomes consisted of the improvement of the Patient's Global Assessment (PaGA) scores, Clinician's Erythema Assessment (CEA) scores, and adverse events (AEs). We used Bayesian random effects models for multiple treatment comparisons. Results: We identified 1,703 results through these databases. Thirty-one randomized trials with 8,226 patients were included. The heterogeneity and inconsistency between the trials were low, with a low risk of bias of all trials. Oral doxycycline 40 mg, minocycline 100 mg, and minocycline 40 mg, as well as topical ivermectin and metronidazole 0.75%, were effective in treating papules and pustules, thereby decreasing IGA in rosacea. Among these, minocycline 100 mg ranked top in efficacy. As for improving the PaGA scores, topical ivermectin, metronidazole 1%, and systemic oxytetracycline were effective, of which oxytetracycline worked the best. Both doxycycline 40 mg and metronidazole 0.75% presented no therapeutic effect for erythema. Considering the safety of the agents, systemic application of azithromycin and doxycycline 100 mg significantly increase the risk of AEs. Conclusion: Our review suggests that a high dosage of systemic minocycline is the most effective in treating rosacea phenotypes with papules and pustules with a low risk of AEs. However, there were no sufficient evidence-based data in exploring the influence of antibiotics on erythema. The phenotype of rosacea should be taken into consideration along with benefit and safety when making prescriptions due to AEs. Clinical Trial Registration: NCT(2016): http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/962/CN-01506962/frame.html NCT(2017): http://cochranelibrary-wiley.com/o/cochrane/clcentral/articles/764/CN-01565764/frame.html. PMID:37251342 | PMC:PMC10210163 | DOI:10.3389/fphar.2023.1169916 {url} = URL to article
    • Taiwan J Ophthalmol. 2023 Jan 5;13(1):80-83. doi: 10.4103/tjo.TJO-D-22-00079. eCollection 2023 Jan-Mar. ABSTRACT A 24-year-old woman visited our emergency department due to intermittent dull pain in the right eye, blurred vision, foreign body sensation for 3 weeks, and progressive facial rash with pustules for 3 months. She had a history of recurring skin rash on her face and extremities since early adolescence. Peripheral ulcerative keratitis (PUK) was diagnosed based on slit-lamp examination and corneal topography and then granulomatous rosacea (GR) based on clinical manifestations and skin pathology. Topical prednisolone, artificial tears, oral doxycycline, oral prednisolone, and topical clindamycin were administered. After 1 month, PUK progressed to corneal perforation probably due to eye rubbing. The corneal lesion was repaired with a glycerol-preserved corneal graft. A dermatologist prescribed oral isotretinoin for 2 months in conjunction with topical betamethasone gradually tapered for 14 months. After 34 months of follow-up, no signs of skin and ocular recurrence were noted, and the cornea graft was intact. In conclusion, PUK may present with GR, and oral isotretinoin may be an effective therapy for PUK in the setting of GR. PMID:37252167 | PMC:PMC10220430 | DOI:10.4103/tjo.TJO-D-22-00079 {url} = URL to article
    • Diagnostics (Basel). 2023 May 12;13(10):1718. doi: 10.3390/diagnostics13101718. ABSTRACT Demodex folliculorum and Demodex brevis are commonly present on facial skin and frequently noted via Reflectance Confocal Microscopy (RCM) examination. These mites inhabit follicles and are often seen in groups of two or more, although D. brevis is usually found as a solitary mite. When observed through RCM, they are typically present as refractile, round groupings seen on a transverse image plane inside the sebaceous opening, as they are vertically oriented, and their exoskeletons refract under near-infrared light. Inflammation may occur, leading to a variety of skin disorders; nonetheless, these mites are considered to be part of normal skin flora. a 59-year-old woman presented to our dermatology clinic for confocal imaging (Vivascope 3000, Caliber ID, Rochester, NY, USA) of a previously excised skin cancer for margin evaluation. She did not exhibit symptoms of rosacea or active inflammation of the skin. Incidentally, a solitary demodex mite was noted in a milia cyst nearby the scar. The mite appeared to be trapped in the keratin-filled cyst and was positioned horizontally to the image plane such that its entire body was captured in a coronal orientation as a stack. Demodex identification using RCM can provide clinical diagnostic value in the context of rosacea or inflammation; in our case, this solitary mite was thought to be part of the patient's normal skin flora. Demodex are practically ubiquitous on the facial skin of older patients and are frequently noted during RCM examination; however, the orientation of the mite referenced herein is uncommon, allowing for a unique view of its anatomy. The use of RCM to identify demodex may become more routine as access to technology grows. PMID:37238202 | PMC:PMC10217450 | DOI:10.3390/diagnostics13101718 {url} = URL to article
    • Skin Res Technol. 2023 May;29(5):e13328. doi: 10.1111/srt.13328. ABSTRACT OBJECTIVES: This study aims to introduce compound glycyrrhizin injection for the treatment of rosacea by mesoderm therapy, and further analyze the therapeutic and aesthetic effects of this treatment method and its impact on the dermatological quality of life index, which provides new ideas and methods for cosmetic dermatology treatment of rosacea. METHODS: The recruited rosacea patients were divided into Control group (n = 58) and observation group (n = 58) according to the random number table. The control group was treated with topical metronidazole clindamycin liniment, and the study group was additionally used mesoderm introduction of compound glycyrrhizin injection. The transepidermal water loss (TEWL), water content in corneum, and dermatology life quality index (DLQI) in rosacea patients were evaluated. RESULTS: Our results showed that the scores of erythema, flushing, telangiectasia, and papulopustule were significantly reduced in the observation group. In addition, the observation group significantly decreased TEWL and increased the water content of the stratum corneum. Furthermore, the observation group significantly reduced the DLQI of rosacea patients compared to the control group. CONCLUSION: The use of mesoderm therapy combined with compound glycyrrhizic acid has a therapeutic effect on facial rosacea and improves patient satisfaction. PMID:37231926 | DOI:10.1111/srt.13328 {url} = URL to article
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