International recommendations that aim to transition current rosacea classification, diagnosis and treatment from subtypes to a phenotype approach, based on signs and symptoms of rosacea, have been published in the British Journal of Dermatology.1,2These recommendations address a need to improve outcomes for patients with rosacea through better identification and personalised treatment of signs and symptoms that bother each patient most.
Rosacea, a chronic inflammatory skin disease, which can also affect the eyes, has traditionally been diagnosed and treated based on four subtypes, depending on the regional classification applied. However, this did not adequately address the potential spectrum of signs and symptoms (or ‘phenotypes’) of individual patients of which can span more than one subtype and progress or ameliorate between subtypes.3
ROSCO Panel Co-Chair Dr Jerry Tan, Adjunct Professor of Internal Medicine and Dermatology, University of Western Ontario, Canada, commented, “Given the overlap of rosacea features across subtypes and the fact that no single treatment completely addresses all rosacea features, the current approach of diagnosing and treating rosacea by subtype may hinder individualised patient management. A new approach is needed to bring us closer to helping each and every rosacea patient receive the right treatment according to their signs and symptoms.”
The ROSCO recommendations, published in the British Journal of Dermatology, re-evaluate current approaches to rosacea diagnosis and treatment and seek to improve outcomes for patients. The international expert panel recommends an approach for diagnosis and classification of rosacea based on the presenting features, optimising individualised rosacea management and enabling physicians to take a more sign/symptom-led approach to addressing patient needs.
“As part of the ROSCO recommendations, the expert panel has taken a positive step to develop a sign/symptom-led treatment algorithm. This will support physicians and patients to better address the disease features most bothersome to each patient. It will also help ensure we, as physicians, prescribe the right treatment combination for our patients,” said ROSCO Panel Co-Chair Professor Dr. Martin Schaller, Department of Dermatology, Tübingen University Hospital, Tübingen, Germany.
The panel integrated clinical experience and evidence from the 2015 Cochrane systematic review on ‘interventions for rosacea’, to achieve consensus on a recommended treatment approach for signs and symptoms of rosacea.4 ROSCO panellist and lead author of the 2015 Cochrane Review Dr Esther J. van Zuuren, Dermatologist, Leiden University Medical Centre, The Netherlands, said, “While the rosacea management landscape has advanced, the current subtype-based view of the disease can hinder progress by limiting the way we consider treatment options. These new ROSCO recommendations should help to make a positive impact on future treatment development and ultimately help improve the lives of people with rosacea through a symptom-led approach.”
Notes to Editors
About the Global ROSacea Consensus (ROSCO) panel
The Global ROSacea COnsensus (ROSCO) panel included 17 dermatologists from Africa, Asia, Europe, North America and South America and three ophthalmologists from Europe and North America. Panel members reached consensus on critical aspects of rosacea diagnosis and treatment by a modified Delphi approach (e-surveys and face-to-face meeting), by voting on each statement: strongly disagree, disagree, agree or strongly agree (consensus defined as ≥75% agree/strongly agree). Statements that did not reach consensus in e-surveys were refined through nominal group discussion at the meeting and re-voted on. All voting was electronic and blinded.
Galderma funded the project but was not involved in the voting, discussion or handling of data.
About the British Journal of Dermatology
The journal is published by Wiley on behalf of the British Association of Dermatologists, the central association of practising UK dermatologists. The organization’s aim is to continually improve the treatment and understanding of skin disease. For further information, visit www.bad.org.uk
Wiley is the international scientific, technical, medical, and scholarly publishing business of John Wiley & Sons, with strengths in every major academic and professional field and partnerships with many of the world's leading societies. For more information, please visit www.wiley.com.
Tan J, et al. Updating the diagnosis, classification and assessment of rosacea: Recommendations from the global ROSacea Consensus (ROSCO) panel. Br J Dermatol. 2016 Oct 8. doi: 10.1111/bjd.15122. [Epub ahead of print].
Schaller M, et al. Rosacea treatment update: Recommendations from the global ROSacea Consensus (ROSCO) panel. Br J Dermatol. 2016 Nov 12. doi: 10.1111/bjd.15173. [Epub ahead of print].
Tan J, et al. An observational cross-sectional survey of rosacea: clinical associations and progression between subtypes. Br J Dermatol. (2013) 169, pp555–562.
van Zuuren EJ, Fedorowicz Z, Carter B, van der Linden MM, Charland L. Interventions for rosacea. Cochrane Database Syst Rev. 2015 Apr 28; (4):CD003262. Epub 2015 Apr 28.
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Last updated on: 15/11/2016
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