When the National Rosacea Society published the first diagnostic guidelines for rosacea in 2002, it ushered in an unprecedented era of research into this widespread, chronic facial skin disorder now estimated to affect more than 16 million Americans. This has led not only to major advances in the understanding of the disease, but important insights into how to recognize and treat it.

“Even though signs of rosacea have been documented in art and literature for centuries, virtually all that is understood about this disorder in medical science has been discovered in the last 15 years,” said Dr. Richard Gallo, chairman of dermatology at the University of California-San Diego, who headed a committee and review panel of 28 rosacea experts in the development of new, updated standard diagnostic guidelines, published late last year.1 “Unlike the mysteries of the past, dermatologists are now able to identify the various signs and symptoms of rosacea based on a thorough understanding of the disease process.”

Although the exact cause remains unknown, recent studies have shown that rosacea’s initial redness appears to be the start of an inflammatory continuum triggered by a combination of neurovascular dysregulation and the innate immune system. The most common presentations of signs and symptoms were previously grouped as subtypes, but the new system focuses on the individual characteristics, called phenotypes, that may be different in each sufferer. This new phenotype system encourages consideration of the full range of potential signs and symptoms that may occur in any individual rosacea sufferer, and assessment of severity and the selection of treatment may be more precisely tailored.

According to the new system, a diagnosis of rosacea may be considered in the presence of at least one diagnostic phenotype – either persistent redness of the central facial skin (erythema) or, less commonly, thickened skin in the central face (known as phymatous changes, often on the nose).
Two or more major signs, including papules and pustules, flushing, telangiectasia, and eye irritation (ocular rosacea), may also indicate rosacea. Secondary signs and symptoms, such as burning or stinging, edema, and dry appearance, may also develop but are not diagnostic.

“Although rosacea’s various phenotypes may appear in different combinations at different times, research suggests that all are manifestations of the same underlying disease process, and that rosacea may progress not only in severity but to include additional signs and symptoms,” said Gallo.

Clients who may have rosacea can be referred to a dermatologist for diagnosis and appropriate care and can visit the National Rosacea Society website at rosacea.org.

Reference

1 Gallo, RL, RD Granstein, S Kang, et al. “Standard classification and pathophysiology of
rosacea: The 2017 update by the National Rosacea Society Expert Committee.” J Am Acad Dermatol 78, no. 1 (2018): 148-155. doi: 10.1016/j.jaad.2017.08.037.

Emma Terhaar is the National Rosacea Society’s social media editor and a contributing writer for the quarterly publication Rosacea Review. The National Rosacea Society is the world’s largest organization dedicated to improving the lives of the estimated 16 million Americans who suffer from this widespread, but poorly understood, disorder. Visit rosacea.org to learn more.