Recommendations for rosacea diagnosis, classification and management: update from the global ROSacea COnsensus 2019 panel

M Schaller, L M C Almeida, A Bewley, B Cribier, J Del Rosso, N C Dlova, R L Gallo, R D Granstein, G Kautz, M J Mannis, G Micali, H H Oon, M Rajagopalan, M Steinhoff, E Tanghetti, D Thiboutot, P Troielli, G Webster, M Zierhut, E J van Zuuren, J Tan, M Schaller, L M C Almeida, A Bewley, B Cribier, J Del Rosso, N C Dlova, R L Gallo, R D Granstein, G Kautz, M J Mannis, G Micali, H H Oon, M Rajagopalan, M Steinhoff, E Tanghetti, D Thiboutot, P Troielli, G Webster, M Zierhut, E J van Zuuren, J Tan

Abstract

Background: A transition from a subtyping to a phenotyping approach in rosacea is underway, allowing individual patient management according to presenting features instead of categorization by predefined subtypes. The ROSacea COnsensus (ROSCO) 2017 recommendations further support this transition and align with guidance from other working groups.

Objectives: To update and extend previous global ROSCO recommendations in line with the latest research and continue supporting uptake of the phenotype approach in rosacea through clinical tool development.

Methods: Nineteen dermatologists and two ophthalmologists used a modified Delphi approach to reach consensus on statements pertaining to critical aspects of rosacea diagnosis, classification and management. Voting was electronic and blinded.

Results: Delphi statements on which the panel achieved consensus of ≥ 75% voting 'Agree' or 'Strongly agree' are presented. The panel recommends discussing disease burden with patients during consultations, using four questions to assist conversations. The primary treatment objective should be achievement of complete clearance, owing to previously established clinical benefits for patients. Cutaneous and ocular features are defined. Treatments have been reassessed in line with recent evidence and the prior treatment algorithm updated. Combination therapy is recommended to benefit patients with multiple features. Ongoing monitoring and dialogue should take place between physician and patients, covering defined factors to maximize outcomes. A prototype clinical tool (Rosacea Tracker) and patient case studies have been developed from consensus statements.

Conclusions: The current survey updates previous recommendations as a basis for local guideline development and provides clinical tools to facilitate a phenotype approach in practice and improve rosacea patient management. What's already known about this topic? A transition to a phenotype approach in rosacea is underway and is being recommended by multiple working groups. New research has become available since the previous ROSCO consensus, necessitating an update and extension of recommendations. What does this study add? We offer updated global recommendations for clinical practice that account for recent research, to continue supporting the transition to a phenotype approach in rosacea. We present prototype clinical tools to facilitate use of the phenotype approach in practice and improve management of patients with rosacea.

© 2019 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.

Figures

Figure 1
Figure 1
The ROSacea COnsensus (ROSCO) modified Delphi process.
Figure 2
Figure 2
Usage and reception of the phenotype approach in rosacea. (a) The extent to which ROSacea COnsensus (ROSCO) panel members report using a phenotype approach for rosacea diagnosis and classification before and after the ROSCO 2017 recommendations (n = 20). (b) The extent to which ROSCO panel members report using a phenotype approach for rosacea management and treatment before and after the ROSCO 2017 recommendations (n = 20). (c) Response of ROSCO panellists’ colleagues to the phenotype approach in rosacea in daily practice and at scientific meetings (n = 21).

References

    1. Wilkin J, Dahl M, Detmar M et al Standard classification of rosacea: report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea. J Am Acad Dermatol 2002; 46:584–7.
    1. van Zuuren EJ, Graber MA, Hollis S et al Interventions for rosacea. Cochrane Database Syst Rev 2004; CD003262.
    1. van Zuuren EJ, Graber MA, Hollis S et al Interventions for rosacea. Cochrane Database Syst Rev 2005; CD003262.
    1. van Zuuren EJ, Kramer S, Carter B et al Interventions for rosacea. Cochrane Database Syst Rev 2011; CD003262.
    1. van Zuuren EJ, Fedorowicz Z, Carter B et al Interventions for rosacea. Cochrane Database Syst Rev 2015; CD003262.
    1. Dahl MV. Rosacea subtypes: a treatment algorithm. Cutis 2004; 74:21–7.
    1. Odom R. The nosology of rosacea. Cutis 2004; 74:5–8.
    1. Powell FC. Clinical practice. Rosacea. N Engl J Med 2005; 352:793–803.
    1. Goldgar C, Keahey DJ, Houchins J. Treatment options for acne rosacea. Am Fam Physician 2009; 80:461–8.
    1. Odom R, Dahl M, Dover J et al Standard management options for rosacea, part 1: overview and broad spectrum of care. Cutis 2009; 84:43–7.
    1. Reinholz M, Tietze JK, Kilian K et al Rosacea – S1 guideline. J Dtsch Dermatol Ges 2013; 11:768–80.
    1. Tan J, Steinhoff M, Berg M et al Shortcomings in rosacea diagnosis and classification. Br J Dermatol 2017; 176:197–9.
    1. Tan J, Almeida LMC, Bewley A et al Updating the diagnosis, classification and assessment of rosacea: recommendations from the global ROSacea COnsensus (ROSCO) panel. Br J Dermatol 2017; 176:431–8.
    1. Tan J, Berg M, Gallo RL, Del Rosso JQ. Applying the phenotype approach for rosacea to practice and research. Br J Dermatol 2018; 179:741–6.
    1. Del Rosso JQ, Thiboutot D, Gallo R et al Consensus recommendations from the American Acne & Rosacea Society on the management of rosacea, part 1: a status report on the disease state, general measures, and adjunctive skin care. Cutis 2013; 92:234–40.
    1. Gallo RL, Granstein RD, Kang S et al Standard classification and pathophysiology of rosacea: the 2017 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol 2018; 78:148–55.
    1. Schaller M, Almeida LMC, Bewley A et al Rosacea treatment update: recommendations from the global ROSacea COnsensus (ROSCO) panel. Br J Dermatol 2017; 176:465–71.
    1. van Zuuren EJ, Fedorowicz Z, Tan J et al Interventions for rosacea based on the phenotype approach: An updated systematic review including GRADE assessments. Br J Dermatol 2019; 181:65–79.
    1. Reinholz M, Ruzicka T, Steinhoff M et al Pathogenesis and clinical presentation of rosacea as a key for a symptom‐oriented therapy. J Dtsch Dermatol Ges 2016; 14 (Suppl. 6):4–15.
    1. Woo YR, Lim JH, Cho DH, Park HJ. Rosacea: molecular mechanisms and management of a chronic cutaneous inflammatory condition. Int J Mol Sci 2016; 17:E1562.
    1. Drucker AM. Taking steps to improve the assessment and management of rosacea. Br J Dermatol 2017; 176:283–4.
    1. Rosacea: Beyond the visible. Available at: (last accessed 3 July 2019).
    1. Webster G, Schaller M, Tan J et al Defining treatment success in rosacea as ‘clear’ may provide multiple patient benefits: results of a pooled analysis. J Dermatolog Treat 2017; 28:469–74.
    1. Harper J, Del Rosso JQ, Ferrusi IL. Cross‐sectional survey of the burden of illness of rosacea by erythema severity. J Drugs Dermatol 2018; 17:150–8.
    1. Thomas CL, Kim B, Lam J et al Objective severity does not capture the impact of rosacea, acne scarring and photoaging in patients seeking laser therapy. J Eur Acad Dermatol Venereol 2017; 31:361–6.
    1. Gallo RL, Granstein RD, Kang S et al Rosacea comorbidities and future research: the 2017 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol 2018; 78:167–70.
    1. Asai Y, Tan J, Baibergenova A et al Canadian clinical practice guidelines for rosacea. J Cutan Med Surg 2016; 20:432–45.
    1. Al‐Amry MA, Al‐Ghadeer HA. Ocular acne rosacea in tertiary eye center in Saudi Arabia. Int Ophthalmol 2016; 38:59–65.
    1. Gold LS, Papp K, Lynde C et al Treatment of rosacea with concomitant use of topical ivermectin 1% cream and brimonidine 0.33% gel: a randomized, vehicle‐controlled study. J Drugs Dermatol 2017; 16:909–16.
    1. Del Rosso JQ, Johnson S, Jackson M. Combined doxycycline 40 mg modified release capsules plus ivermectin 1% cream therapy for severe papulopustular rosacea. Presented at Fall Clinical Dermatology, Las Vegas, CA, U.S.A., 18–21 October 2018.
    1. . Oracea soolantra association in patients with severe rosacea (ANSWER). Available at: (last accessed 3 July 2019).
    1. Steinhoff M, Vocanson M, Voegel JJ et al Topical ivermectin 10 mg/g and oral doxycycline 40 mg modified‐release: current evidence on the complementary use of anti‐inflammatory rosacea treatments. Adv Ther 2016; 33:1481–501.
    1. Armon K, Stephenson T, MacFaul R et al An evidence and consensus based guideline for acute diarrhoea management. Arch Dis Child 2001; 85:132–42.
    1. Jones J, Hunter D. Consensus methods for medical and health services research. BMJ 1995; 311:376–80.
    1. Fletcher AJ, Marchildon GP. Using the Delphi method for qualitative, participatory action research in health leadership. Int J Qual Methods 2014; 13:1–18.

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