The National Rosacea Society has introduced the first standard classification system for the diagnosis and study of rosacea, developed by a consensus committee of rosacea experts and reviewed by authorities on rosacea worldwide. 1
"The new standard classification system should help broaden the utility of future research as well as aid in the clinical diagnosis of this complex disorder," said Dr. Jonathan Wilkin, chairman of the consensus committee. "Because of the diverse manifestations of rosacea and the absence of histological or serological markers, the new system provides a standard investigative instrument that is essential to conduct research, analyze results and compare data from different sources."
He noted that the standard terminology should also help clarify future communications on the disorder.
In addition to Dr. Wilkin, consensus committee members included Dr. Mark Dahl, Dr. Michael Detmar, Dr. Lynn Drake, Dr. Richard Odom and Dr. Frank Powell -- all members of the Society's medical advisory board -- as well as the late Dr. Alvan Feinstein, professor of epidemiology and public health at Yale University and a leading authority on classification systems. Ten additional rosacea experts also reviewed and contributed to the standard system, which is expected to be updated as new research discoveries are made and new understandings of rosacea are formulated.
The new system identifies the primary and secondary features of rosacea, and emphasizes that in most cases some rather than all appear in any individual patient. Primary features include flushing, persistent redness, bumps and pimples, and visible blood vessels. Secondary features include burning and stinging, plaque (raised red patches), dry appearance, edema (swelling) and ocular (eye) manifestations.
The most common patterns of signs and symptoms are then designated as specific subtypes.
Subtype 1, called erythematotelangiectatic rosacea, is characterized by flushing and persistent redness (erythema) on the central face. The appearance of visible blood vessels (telangiectases) is common but not essential. Swelling, stinging or burning, and roughness or scaling may also be commonly seen.
Subtype 2, called papulopustular rosacea, features persistent facial redness with papules or pustules that come and go, primarily on the central face. While this subtype may resemble acne vulgaris, blackheads are absent, and burning or stinging may also occur.
Subtype 3, called phymatous rosacea, includes thickening skin, irregular nodularities and enlargement -- especially of the nose (rhinophyma), although enlargement may occur in other locations.
Subtype 4 is ocular rosacea. The eyes may have a watery or bloodshot appearance, the sensation of a foreign body, burning or stinging, dryness, itching, light sensitivity or a host of other signs and symptoms. Sties are a common sign of rosacea-related ocular disease, and some individuals may have decreased visual acuity due to corneal complications.
A full report on the new standard classification system was published in the April issue of the Journal of the American Academy of Dermatology, and reprints may be obtained by writing the National Rosacea Society or calling toll-free at 1-888-NO-BLUSH or emailing at email@example.com.
Wilkin J, Dahl M, Detmar M, Drake L, et al. Standard classification of rosacea: Report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea. Journal of the American Academy of Dermatology. 2002;46:584-587.