There is still room for improvement to the National Rosacea Society (NRS) Expert Committee's updated classification schema for rosacea, according to William James, M.D., a professor of dermatology at the University of Pennsylvania in Philadelphia.
The new guidelines, published in 2018, have abandoned the four main subtypes (erythematolelangiectatic [ETR], papulopustular, phymatous and ocular), replacing them with a phenotype system based upon mostly observable findings.
“Shifting from a subtype focus to individual clinical findings or a phenotype classification allows both for better selection of treatment modalities and improved ability to conduct research,” says Dr. James, co-author of a recent clinical review that evaluates the new rosacea classification and its controversies.1
“By subtyping, there was unnecessary division of interrelated disease into individual disorders; an individual’s clinical presentation might fall along a spectrum rather than within a discrete box,” the authors write.
“Each manifestation is now approached individually, which allows for more exibility and better care,” Dr. James tells Dermatology Times. However, he believes refinements should be made in some of the definitions of the clinical characteristics of rosacea, “not only specifying more precisely the features which comprise the diagnostic findings, but also expanding the list of diseases that need to be excluded when making the diagnosis of rosacea. For instance, providing timelines to fixed erythema and ushing, including periocular sparing in the list of characteristic features, and aiding in assessing how chronic solar damage may be differentiated would be helpful.”
Dr. James reports no relevant fi nancial disclosures
1. Wang YA, James WD. “Update on rosacea classification and its controversies,” Cutis. 2019 Jul;104(1):70-73.