The National Rosacea Society (NRS) recently organized a roundtable discussion of thought leaders in rosacea to discuss facial erythema in light of the new standard classification system, recent burden-of-illness studies, the new standard management options and significant advances in medical therapy and patient care. The main discussion points are summarized in this article.
Recent developments in rosacea call for clinicians to place greater emphasis on persistent facial erythema, one of the most common and troublesome features of the disorder, now designated as its most prevalent diagnostic phenotype. New therapies, often used in combinations, are increasingly addressing this manifestation, and are most successfully employed when collaborating with the patient to identify expectations, ensure effective application, and achieve optimal outcomes.
Clinicians should now consider rosacea as a single disease with multiple potential phenotypes. Drawing from current scientific knowledge as well as clinical experience, the recently updated standard classification of rosacea has shifted away from subtypes and identifies the various phenotypes that may occur in many possible combinations in individual patients (Table 1).1 Persistent facial erythema is a diagnostic phenotype, and phymatous changes, although less common, are also diagnostic. Major signs include papules and pustules, flushing, telangiectasia, and certain ocular manifestations. The presence of any two of the major phenotypes also may be considered diagnostic, and secondary phenotypes include burning, stinging, edema, and dryness. Rosacea therefore encompasses a multitude of possible combinations of signs and symptoms.
An important advantage for physicians in using the new classification system is its emphasis on a diverse collection of individual signs and symptoms, as well as their potential interrelationship. Notably, recent studies have shown that rosacea’s features, from erythema to papules and pustules to phymatous changes, appear to be part of a consistent continuum of inflammation.2-5 Although rosacea’s various phenotypes may appear in different combinations and at different times, research suggests that they all may be manifestations of this underlying inflammatory process, and that rosacea may evolve