“Clinical checklist” updated to better diagnose, treat rosacea patients
Leading rosacea researchers from around the world, including a Canadian, have changed the “clinical checklist” physicians use to diagnose and treat the condition based on new insights into the disease.
Rosacea is a common skin condition affecting 3 million Canadians. Experts suspect rosacea is underdiagnosed and that many do not know they have it (1).
Rosacea was classified into 4 subtypes in 2002: flushing and facial redness; facial redness with pimples; thickened facial skin and inflammation of the eyes.
“One of the problems with the old system was that in reality people often develop 2 and even 3 subtypes of rosacea at the same time,” according to Dr. Jason Rivers, Vancouver dermatologist and president of the Acne and Rosacea Society of Canada.
“There was also not enough consideration given to some of the most significant features of rosacea such as fixed central facial redness. Plus there was little information to help judge the severity of the condition. We know that even with mild rosacea, there can be negative impacts on personal, family and work life so we need to be able to gauge severity holistically,” says Dr. Rivers.
Over the past 15 years, researchers have found that rosacea is likely due to a combination of causes and reactions within the body and consequently appears in many different ways.
“The updated guide (2) is based on phenotype – observable, individual characteristics likely resulting from genetic or environmental influences – and is a clearer and more meaningful guide for diagnosis and treatment,” Dr. Rivers adds.
Under the revised classification, having just one of these two hallmark signs of rosacea is enough to make a rosacea diagnosis (see chart)
- Persistent facial redness on the cheeks, nose, chin or forehead OR
- Thickening of the skin on the nose, ears or chin
If the above two features are not present, doctors can still diagnose rosacea if two or more of these major features (see chart):
- papules and pustules (pimples)
- flushing (transient redness with burning or hot sensation)
- small broken blood vessels
- eye and eyelid problems
The guide also lists secondary signs that can support a rosacea diagnosis: skin burning or stinging, facial redness that comes and goes; very dry, rough skin; eye and eyelid problems (see chart).
“Based on what we have learnt about rosacea since it was first classified, the updated guide intends to provide accuracy and flexibility to diagnose and treat rosacea, creating better outcomes for those with this common condition,” says Dr. Rivers.
(1) Acne and Rosacea Society of Canada, Survey: Most Canadians cannot identify common signs of rosacea” https://www.rosaceahelp.ca/news-releases/rosacea-awareness-month-news-release-survey-canadians-cannot-identify-rosacea/
(2) Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee. Gallo RL, Granstein RD, Kang S, Mannis M, Steinhoff M, Tan J, Thiboutot D. J Am Acad Dermatol. 2018 Jan;78(1):148-155. doi: 10.1016/j.jaad.2017.08.037
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Dermatologist spokespeople for the Acne and Rosacea Society of Canada are available for comment:
Dr. Jason Rivers, Vancouver; Dr. Jerry Tan, Windsor, Dr. Benjamin Barankin, Toronto, Dr. Marni Wiseman, Winnipeg; Dr. Catherine Zip, Calgary, Dr. Shannon Humphrey, Vancouvrer; Dr. Marcie Ulmer, Vancouver
- “Clinical Checklist” Chart
- Persistent Facial Redness on the cheeks
- Thickening of the skin on the nose
- Facts and Stats – Rosacea 2019
*April 2019 is designated Rosacea Awareness Month throughout North America to raise awareness about this common skin condition.