Aug 15, 2019
Rosacea diagnosis relies on clinical judgment. Dr. Vincent DeLeo
talks to Dr. William James about
rosacea classification and its controversies. Dr. James
describes the evolution of rosacea classification systems and the
need to define the clinical features of rosacea to improve patient
care. “There is no gold-standard laboratory diagnosis for
[rosacea],” Dr. James explains. “It’s really a diagnosis that’s
made on clinical criteria, so those criteria I think should be well
We also bring you the latest dermatology news and research.
sunscreen: Skin cancer preventive agents finding a role
A growing list of skin cancer chemopreventive agents is
expanding options for risk management.
patients on biologics show improved heart health
Novel imaging biomarker identifies reduced coronary inflammation
in psoriasis patients on biologics.
found effective for adolescents with moderate to severe atopic
The rates of skin infections also were higher in the placebo
group, compared with the treatment groups.
Things you will learn in this episode:
- There are three published rosacea classification systems based
on clinical presentation, including the original classification
schema introduced by the National Rosacea Society in 2002 and
updated in 2018 as well as a similar classification system
published by the global ROSacea COnsensus panel in 2017.
- The initial classification system included a list of primary
and secondary features that were considered diagnostic of rosacea,
but no standardized group of characteristics has been shown to be
applicable in all cases of rosacea.
- The newer classification systems focus more on identifying
phenotypic changes in rosacea patients rather than classifying
subtypes of disease, as not every rosacea patient presents with a
classic constellation of symptoms.
- Targeting individual symptoms of rosacea allows for more
specific treatments based on a patient’s unique clinical
presentation rather than designing therapies for broad
- Despite advancements made in the newer classification systems,
some of the definitions of primary features of classification still
require more refinement; for instance, the classifications address
flushing in rosacea as a very quick reaction, occurring within
seconds to minutes of a trigger, but they do not address the
prolonged nature of the redness, which is not as transient as in
people who are simply embarrassed or overheated from exercise.
- Although it was included in the initial classification schema,
granulomatous rosacea was eliminated in the newer classifications,
likely because it does not share commonalities with traditional
- When diagnosing rosacea, it is important to consider other
disease states that can lead to a red face and are in fact
associated with diagnostic laboratory values or histopathologic
appearances, such as systemic lupus, dermatomyositis, mastocytosis,
carcinoid syndrome, polycythemia vera, and diabetes, as these
conditions are more serious from a systemic standpoint.
- New treatment algorithms for rosacea focus on treating specific
phenotypes rather than groups of symptoms, leading to more targeted
therapies that can be used to treat individual patient
Hosts: Elizabeth Mechcatie, Terry Rudd, Vincent A. DeLeo, MD (Keck
School of Medicine of the University of Southern California, Los
Guest: William D. James, MD (University of Pennsylvania School
of Medicine, Philadelphia)
Show notes by: Alicia Sonners, Melissa Sears, Elizabeth
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