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Updating the diagnosis, classification and assessment of rosacea: recommendations from the global ROSacea COnsensus (ROSCO) panel.

Department of Medicine, University of Western Ontario, Windsor, ON, Canada. Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil. Whipps Cross University Hospital, London, U.K. Royal London Hospital, London, U.K. Department of Dermatology, Hopitaux Universitaires de Strasbourg, Strasbourg, Alsace, France. Department of Dermatology, University of KwaZulu-Natal College of Health Sciences, Durban, South Africa. Department of Dermatology, University of California San Diego, La Jolla, CA, U.S.A. Haut- und Laserklinik, Konz, Germany. Department of Ophthalmology and Vision Science, University of California Davis, Davis, CA, U.S.A. National Skin Centre, Singapore, Singapore. Department of Dermatology, Apollo Hospitals Enterprise, Chennai, Tamil Nadu, India. Department of Dermatology and UCD Charles Institute for Translational Dermatology, University College Dublin, Dublin, Ireland. Department of Dermatology, Pennsylvania State University College of Medicine, Hershey, PA, U.S.A. Faculty of Dermatology, School of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina. Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, U.S.A. Department of Dermatology, Peking University First Hospital, Beijing, China. Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands. Department of Dermatology, Universitatsklinikum Tubingen, Tubingen, Baden-Württemberg, Germany.

The British journal of dermatology. 2017;(2):431-438
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Abstract

BACKGROUND Rosacea is currently diagnosed by consensus-defined primary and secondary features and managed by subtype. However, individual features (phenotypes) can span multiple subtypes, which has implications for clinical practice and research. Adopting a phenotype-led approach may facilitate patient-centred management. OBJECTIVES To advance clinical practice by obtaining international consensus to establish a phenotype-led rosacea diagnosis and classification scheme with global representation. METHODS Seventeen dermatologists and three ophthalmologists used a modified Delphi approach to reach consensus on statements pertaining to critical aspects of rosacea diagnosis, classification and severity evaluation. All voting was electronic and blinded. RESULTS Consensus was achieved for transitioning to a phenotype-based approach to rosacea diagnosis and classification. The following two features were independently considered diagnostic for rosacea: (i) persistent, centrofacial erythema associated with periodic intensification; and (ii) phymatous changes. Flushing, telangiectasia, inflammatory lesions and ocular manifestations were not considered to be individually diagnostic. The panel reached agreement on dimensions for phenotype severity measures and established the importance of assessing the patient burden of rosacea. CONCLUSIONS The panel recommended an approach for diagnosis and classification of rosacea based on disease phenotype.

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