The new recommendation allows providers to focus on treating what patients indicate are their most bothersome rosacea symptoms, Dr. Tan says.
Interestingly, Dr. Tan says it’s an approach most of his colleagues are already using.
“We’re simply articulating what is done in practice,” he says.
Some of the 2002 rosacea recommendations by the National Rosacea Society may have led to misunderstandings in terms of grading scale, according to Dr. Tan. In a grading scale of subtype, one has to account for multiple phenotypes. Using a phenotype-led approach makes scale development and phenotype evaluation more simplified and targeted.
Another part of the old recommendations that could have been confusing was the potential for overlapping phenotypes within the subtypes. A case in point: centrofacial erythema is in both subtype one and subtype two.
“In some of the epidemiological research, one could never be sure whether patients were counted separately as subtype one, if they had centrofacial erythema; then, also counted again in patients who also had papules and pustules as a subtype two patient. There was a risk that you would be counted twice,” he says.
A global consensus for good reason
The ROSCO expert panel, including 17 dermatologists and three ophthalmologists, is globally representative.
“We were uncertain of how rosacea manifests in different ethnic groups and skin types and wanted to make sure that Asians were represented as well as Africans and Latinos. So, we had representation from China, Latin America, South America, India, Europe and North America,” Dr. Tan says.
The global representation will help to shed light on research needed to determine whether rosacea is, indeed, a global condition.
“We think it probably is, but it may manifest differently in patients of different skin color and skin tone,” Dr. Tan says.
Part of the problem is that centrofacial erythema presents as redness in light skin but can present as darker shades of brown or purple in darker skin types.
“One of the issues is how to move forward the research agenda of rosacea in patients who are not light photo-types, where you can’t see redness,” he says.
Dr. Tan receives honoraria from Galderma for participating in the panel. He also has been an advisor and/or speaker for Almirall, Bayer, Cipher, Galderma, Stiefel/GSK, Merz, Valeant; consultant to Galderma, Merz, Roche; and clinical investigator for Allergan, Cipher, Dermira and Galderma.
Schaller, M., Almeida, L., Bewley, A., Cribier, B., Dlova, N., Kautz, G., Mannis, M., Oon, H., Rajagopalan, M., Steinhoff, M., Thiboutot, D., Troielli, P., Webster, G., Wu, Y., van Zuuren, E. and Tan, J. (2016), Rosacea treatment update: Recommendations from the global ROSacea COnsensus (ROSCO) panel. Br J Dermatol. Accepted Author Manuscript. doi:10.1111/bjd.15173
Tan J, Steinhoff M, Berg J, Del Rosso A, Layton A, Leyden J, Schauber J, Schaller M, Cribier B, Thiboutot D, Webster G, and the Rosacea International Study Group. Shortcomings in rosacea diagnosis and classification. Br J Dermatol. Perspectives. 18 Jan 2017. P 197-199.