BARRINGTON, Illinois (April 19, 2002) -- The National Rosacea Society announced today that it has introduced the first standard classification system for the diagnosis and study of rosacea, a widespread but poorly understood facial disorder estimated to affect 14 million Americans. A full report on the new system, developed by a consensus committee and reviewed by rosacea experts worldwide, has been published in the April issue of the Journal of the American Academy of Dermatology.
"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. At the same time, it is expected to serve as a diagnostic reference in clinical practice, and the standard terminology should help clarify future communications."
In addition to Dr. Wilkin, the consensus committee included Dr. Frank Powell, consultant dermatologist, Mater Misericordiae Hospital, Dublin, Ireland; Dr. Mark Dahl, chairman of dermatology, Mayo Clinic Scottsdale; Dr. Alvan Feinstein, professor of epidemiology and public health, Yale University, a leading authority on nosology (classification systems); Dr. Lynn Drake, department of dermatology, Harvard Medical School; Dr. Richard Odom, professor of dermatology, University of California at San Francisco; and Dr. Michael Detmar, associate professor of dermatology, Harvard Medical School. Other leading experts in the United States and Europe also reviewed and contributed to the standard system, which is expected to be updated as new research discoveries are made.
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. The most common patterns of signs and symptoms are then designated as specific subtypes.
According to the standard system, the primary features of rosacea are flushing or transient erythema (redness), persistent or nontransient erythema, papules (bumps) and pustules (pimples), and telangiectases (visible blood vessels), all in the central part of the face. The presence of one or more of these signs, which are commonly transient and may appear independently, is indicative of rosacea.
In addition, secondary features of rosacea may include burning or stinging, plaque (raised red patches), a dry appearance, edema (swelling), ocular manifestations, peripheral location and phymatous changes, in which the skin thickens.
Subtype 1, called erythematotelangiectatic rosacea, is characterized by flushing and persistent erythema on the central portion of the face. The appearance of telangiectases is common but not essential. Swelling, stinging or burning, and roughness or scaling as well as a history of flushing may also be commonly seen in these patients.
Subtype 2, called papulopustular rosacea, features persistent facial erythema with transient papules or pustules, primarily on the central face. While this subtype may resemble acne vulgaris, comedones (blackheads) are absent, and burning or stinging may also occur. This subtype has often been observed following or in combination with subtype 1, including the presence of telangiectases.
Subtype 3, called phymatous rosacea, includes thickening skin, irregular nodularities and enlargement -- especially of the nose (rhinophyma), although enlargement may occur in other locations such as the chin, forehead, cheeks and ears. Those with phymatous rosacea also may have telangiectases or large follicles in the area affected. As with subtype 2, phymatous rosacea has frequently been observed following or in combination with other subtypes.
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. Vision loss is a serious risk of this rosacea subtype, and an ophthalmological approach to treatment may be needed.
"Because the etiology and pathogenesis of rosacea are unknown, the new system is based solely on morphological characteristics," Dr. Wilkin said. "However, as scientific knowledge of rosacea increases, we hope that the classification of rosacea will eventually be based on causality as well."
The National Rosacea Society has established a research grants program to support research into the potential causes and other key aspects of rosacea, including such areas as pathogenesis, progression, mechanism of action, cell biology and potential genetic factors. Research in such areas as epidemiology, predisposition, quality of life and relationships with environmental and lifestyle factors may also be funded.
Reprints of the published standard classification system, as well as grant application forms, are available from the National Rosacea Society, 111 Lions Dr., Ste. 216, Barrington, Illinois 60010, telephone 1-888-662-5874, e-mail info@rosacea.org.