(1) Flushing
(2) Persistent Erythema
(3) Telangiectasia
(4) Papulopustular (Papules/pustules Lesion Counts)
(5) Phymatous
(6) Ocular Manifestations

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