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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 of the scalp: Results from a retrospective and prospective randomized controlled study
    • Just an update on the RRDi. As the end of 2023 was getting closer, there simply wasn't enough donations to keep our website going, not to mention other costs to keep a legal 501 C 3 non profit going. There hasn't been any activity in our member forum for some time now, many months. i was resigned to close up the RRDi since members don't post, only a few donate a few dollars a month. Then in October 2023 one of our members, David Peterson, donated $1000 which kept us going for another year. You can view our financial situation since we are transparent. I have devoted hundreds of volunteer hours for the RRDi in the hopes that some new members might turn our non profit into an active rosacea research and development but so far just haven't been able to generate the support we need to engage with anyone coming forward to volunteer and help. The other board members don't post. I haven't posted for sometime now and feel that since there really isn't anyone considering volunteering to actively support the mission of the RRDi, it may be time to simply shut it down. If you are an active member (there are only a few subscribers) could you post your thought on this? I am trying to be positive, but it looks rather bleak that rosacea sufferers want to unite and do anything except post on social media about rosacea. Actually engaging in rosacea research is left to the skin industry. Rosaceans just like rosacea social media sites and hang out there and do absolutely nothing about uniting as rosacea sufferers and doing anything but post in their favorite rosacea social media. Sure hope this thread generates some posts from anyone else, but I am losing hope. 
    • North Clin Istanb. 2024 Jan 31;11(1):27-37. doi: 10.14744/nci.2023.33410. eCollection 2024. ABSTRACT OBJECTIVE: Skincare is a part of rosacea treatment; patients benefit from complementary dermo-cosmetic care as well as medical treatments. Some skincare habits are known to trigger and exacerbate rosacea, but there are very few epidemiological studies on this matter. METHODS: A total of 200 people, including 100 patients with rosacea and 100 controls, were included in the study. We questioned the methods used by the participants in daily facial cleansing. Sun and heat exposure, makeup habits, the history of the use of topical steroids, and outdoor working status were noted. A dermoscopic examination, a non-invasive and valuable method to evaluate the presence and severity of Demodex, was performed. RESULTS: We evaluated 30% of our rosacea patients as erythematotelangiectatic rosacea, 13% as papulopustular rosacea, and 57% of our patients had mixed type, which could not be distinguished from one of these subtypes. In the case group, the proportion of people who used daily facial cleansers and daily soaps was lower than in the control group, while the proportion of those who cleaned their face with only water and those who used facial cleansers less frequently was higher (p<0.001). In the case group, while the rate of daily make-up and use of make-up products was lower (p=0.001, p<0.001, respectively), the rate of not wearing make-up was higher (p=0.001). The history of hot bath use was higher in the case group than in the control group (p=0.011). We found a significant relationship between the severity of plaque and dry appearance and the increase in Demodex density (p=0.007, p<0.001, respectively). CONCLUSION: We recommend that patients with rosacea clean their faces daily with soap or facial cleansers and not take a bath with very hot water. Patients should be evaluated for increased Demodex mites, especially if skin dryness is accompanied. PMID:38357320 | PMC:PMC10861432 | DOI:10.14744/nci.2023.33410 {url} = URL to article
    • J Imaging Inform Med. 2024 Jan 12. doi: 10.1007/s10278-023-00962-2. Online ahead of print. ABSTRACT The human body's largest organ is the skin which covers the entire body. The facial skin is one area of the body that needs careful handling. It can cause several facial skin diseases like acne, eczema, moles, melanoma, rosacea, and many other fungal infections. Diagnosing these diseases has been difficult due to challenges like the high cost of medical equipment and the lack of medical competence. However, various existing systems are utilized to detect the type of facial skin disease, but those approaches are time-consuming and inaccurate to detect the disease at early stages. To address various issues, a deep learning-based gate recurrent unit (GRU) has been developed. Non-linear diffusion is used to acquire and pre-process raw pictures, adaptive histogram equalization (AHE) and high boost filtering (HBF). The image noise is removed by using non-linear diffusion. The contrast of the image is maximized using AHE. The image's edges are sharpened by using HBF. After pre-processing, textural and colour features are extracted by applying a grey level run-length matrix (GLRM) and chromatic co-occurrence local binary pattern (CCoLBP). Then, appropriate features are selected using horse herd optimization (HOA). Finally, selected features are classified using GRU to identify the types of facial skin disease. The proposed model is investigated using the Kaggle database that consists of different face skin disease images such as rosacea, eczema, basal cell carcinoma, acnitic keratosis, and acne. Further, the acquired dataset is split into training and testing. Considering the investigation's findings, the proposed method yields 98.2% accuracy, 1.8% error, 97.1% precision, and 95.5% f1-score. In comparison to other current techniques, the proposed technique performs better. The created model is, therefore, the best choice for classifying the various facial skin conditions. PMID:38343253 | DOI:10.1007/s10278-023-00962-2 {url} = URL to article
    • Int Ophthalmol. 2024 Feb 12;44(1):60. doi: 10.1007/s10792-024-03002-2. ABSTRACT PURPOSE: To analyze higher-order aberrations (HOAs) and their visual impact in a pediatric blepharokeratoconjunctivitis (PBKC) cohort compared with healthy controls. METHODS: Prospective case-control study of pediatric patients (≤ 16 years old). Subjects underwent wavefront aberrometry analysis to compare HOAs and their impact on visual quality. RESULTS: A total of 150 eyes from 76 patients were included in the analysis. The PBKC group consisted of 50 eyes and the control group of 100 healthy eyes. Mean age was 10.39 ± 3.81 years for the PBKC group and 10.80 ± 3.61 years for the controls. Mean corrected-distance visual acuity (CDVA) was 0.24 ± 0.21 logMAR in the PBKC group and 0.07 ± 0.1 in the controls (P < 0.001). Mean astigmatism was 1.6 ± 1.98D in the PBKC group vs. 0.67 ± 0.76D in the control group (P = 0.01). Mean RMS of HOAs was 1.05 ± 1.7mm in the PBKC group and 0.41 ± 0.18mm in the controls (P < 0.001). The mean modulation transfer function (MTF) in the PBKC group was significantly lower (16.37 ± 16.32) than controls (30.3 ± 23.57) (P < 0.001). Corneal leukomas, stromal vascularization, peripheral nummular subepithelial scars, and pannus formation are associated with increased HOAs. CONCLUSIONS: There was a significant increase in total HOAs of eyes with PBKC compared to healthy controls. Corneal opacity, vascularization, and scarring are associated with increased HOAs. The PBKC eye aberration profile: coma, secondary astigmatism, quadrafoil, and pentafoil, were associated with decreased CDVA and visual quality (PSF and MTF). PMID:38345707 | DOI:10.1007/s10792-024-03002-2 {url} = URL to article
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