A recent study in the British Journal of Dermatology makes a case for treating and managing rosacea based on the clinical presentation, or phenotype.


Chronic inflammatory skin disease, rosacea, is typically treated according to subtype and classification given during diagnosis. However, the gaps between subtype and clinical presentation (phenotype) of rosacea can result in less targeted approaches to treatment and less effective results for patients. These issues prompted researchers to assess the merits of a phenotype-based approach to treatment.

A new study in the British Journal of Dermatology (2017) highlights the findings of the international ROSacea COnsensus panel (ROSCO) as a result of their analysis of data from the 2015 Cochrane review on rosacea interventions. With the goal of obtaining a global consensus on the most effective treatment methodologies, 17 dermatologists and 3 ophthalmologists (the international ROSCO panel) used e-surveys and group meetings to assess the Cochrane review data on clinical experiences and outcomes on a scale of very low quality, low, moderate, or high-quality evidence. Advisors would then rate their level of agreement in order to achieve consensus on the most effective treatments, given the available evidence.

The international ROSCO panel was able to reach a consensus on initial, combination, and maintenance therapy using a phenotype-based approach for treating skin features of rosacea. Ophthalmologists on the panel also agreed on an approach to managing ocular rosacea. Results suggest that physicians should select a combination of treatments for rosacea based on presenting features, overall disease activity, and the severity of the features.

Due to a lack of randomized clinical trials regarding patient education or avoidance of trigger factors, the Cochrane review on rosacea interventions did not provide a comprehensive view of treatment options which might take into account patient preferences. Furthermore, the Delphi process by which the panel reached its consensus relies heavily on qualitative analysis on previously collected data. This review did employ countermeasures such as blind voting to avoid risks of bias from the Delphi process. However, further research is required in order to determine the practical efficacy of the proposed “globally applicable treatment algorithm based on phenotype” derived from this study.


Written By: Jennifer Newton

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