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Rosacea Awareness Month highlights new standard classification, pathophysiology

The National Rosacea Society in the U.S. has designated April as Rosacea Awareness Month, to raise public education about the condition and encourage those with warning signs to consult with a dermatologist for diagnosis and appropriate treatment. An updated classification and pathophysiology of rosacea was recently published by the National Rosacea Society (NRS) to serve as an improved diagnostic reference in clinical practice (J Am Acad Dermatol 2018; 78(1):148–155).

“Public awareness and the role of the dermatologist are the keys to relieving the widespread human suffering that is caused by this common disorder,” said Dr. Richard Gallo, chairman of dermatology, University of California-San Diego in La Jolla, Calif. and chair of the NRS consensus committee and review panel, in a press release. “Many rosacea patients are actually relieved when they learn they have a disease, and that it can be controlled with long-term medical therapy.”

Outside of clinical practice, the new classification will also provide researchers with standard criteria essential for analyzing results and comparing data. The new system will also provide common terminology for clear communication among a broad range of investigators, clinicians, and health officials.

Difference from previous classification system

This is the first update of the classification system for rosacea originally published in 2002. The system was designed by 28 medical experts and is based on current advances in rosacea research. Notably, the authors emphasized that there should be added focus on observing phenotypes that may result from the condition. This way, the full range of potential signs and symptoms can be considered. Referring to the new method of classification can also result in a more precise assessment of severity and treatment selection for each individual patient.

For example, the presence of one of two phenotypes—persistent redness of the facial skin or, less commonly, phymatous changes where the facial skin thickens—is considered diagnostic of rosacea. Additional major signs, which often appear with the diagnostic features, include papules and pustules, flushing, telangiectasia, and certain ocular manifestations. The presence of two or more major phenotypes independent of the diagnostic features is also considered diagnostic of rosacea. Secondary phenotypes, which must appear with one or more diagnostic or major phenotypes, include burning or stinging, swelling, and dry appearance.

“It’s now well established that a consistent multivariate disease process underlies the various clinical manifestations of rosacea, and these are now increasingly well understood,” said Dr. Gallo. “At the same time, today there is a much wider range of therapeutic options to treat the various signs and symptoms.”

Potentially serious comorbidities

The NRS also published an accompanying report to the new classification system (J Am Acad Dermatol 2018; 78(1):167–170). It summarized several studies concluding that rosacea diagnosis may be associated with increased risk of serious systemic disorders like cardiovascular, gastrointestinal, neurological, and autoimmune diseases, as well as certain cancers. These results encourage further research into the notion that systemic inflammation may be one of the underlying causes of rosacea.

The Acne and Rosacea Society of Canada is also participating in promoting awareness during Rosacea Month this April. Their campaign is focusing on the potentially serious comorbidities, in an effort to encourage early disease detection.

“Inflammation present in these other conditions is hidden within the body,” said Dr. Jason Rivers, president of the Acne and Rosacea Society of Canada and professor of dermatology, University of British Columbia in Vancouver, in a press release. “However, rosacea appears on the skin making it a visible marker of inflammation that may be helpful as a warning sentinel for these other conditions.”

Educational tools for patients

The Acne and Rosacea Society of Canada released new educational materials for Rosacea Awareness Month such as a new brochure called “Rosacea—Lifestyle and Skincare Tips” and results of a survey on Canadians’ knowledge about rosacea. Throughout April, videos will also be uploaded on their YouTube channel featuring rosacea experts and patients. Their website, provides further information.

In the U.S., educational materials are available to health professionals for their patients through the NRS website at throughout the year. Those interested in spreading awareness during the month of April are encouraged to visit the official Rosacea Awareness Month landing page at, to learn more about how they can participate.

Clinicians can inform their patients that they can call the NRS’s toll-free telephone number at 1–888-NO-BLUSH for information. The NRS also publishes Rosacea Review, a newsletter for rosacea patients; a “Rosacea Diary” to help patients identify and avoid lifestyle factors that may trigger flare-ups in their individual cases; and other booklets to help patients understand and manage their condition.

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