Explaining The New Rosacea Classifications

I try to follow the latest news and updates when it comes to rosacea and I’ve been wanting to write a post addressing the changes to the rosacea classifications for a while… but every time I sit down to write I get bogged down in the scientific jargon and lose interest! But I’ve finally done it – I’ve waded through numerous scientific papers and press releases and broken things down in layman’s terms.

Since 2002, we have categorised rosacea into 4 subtypes:

• Subtype 1 (erythematotelangiectatic) – redness, visible broken veins, and flushing.
• Subtype 2 (papulopustular) – redness and fluid-filled pimple and itchy bumps (sometimes unhelpfully known as acne rosacea).
• Subtype 3 (Rhinophyma/Phymatous) Causes a thickening of the skin, usually on the nose.
• Subtype 4 (ocular rosacea) This is characterised by red and sore eyes that often feel gritty.

These distinct subtypes were not always practical for many in the medical community: it is not uncommon for a single patient to have signs and symptoms of more than one subtype of rosacea; some patients will progress from one subtype to another (as I did); and we all have very different symptoms (e.g. my experience of rosacea type 2 may present very differently to someone else’s).

So, as per this article on Rosacea.org, medical practitioners are now encouraged to use the new rosacea classifications to discuss or classify rosacea in phenotypes (which sounds complicated but basically just means the many different characteristics common to those of us with rosacea). This new approach aims to be a more patient-centric and individual approach to diagnosis and treatment. Overall the Rosacea.org website is a great resource, but the articles can be a little dense and hard to digest, so I’ve tried to break down the key points below.

Because rosacea presents as a consistent inflammatory condition across all sufferers, it’s thought that breaking the symptoms down into more specific individual phenotypes will be more useful. These phenotypes are split into DIAGNOSTIC, MAJOR and SECONDARY:

DIAGNOSTIC PHENOTYPES – To put it simply, if you present with either persistent facial redness or facial skin thickening, this is now enough to get a rosacea diagnosis.

MAJOR PHENOTYPES – Papules and pustules, flushing, telangiectasia (broken veins) and certain ocular manifestations. Major phenotypes often accompany the above diagnostic phenotypes, however even if neither of the diagnostic phenotypes are present, you can still be diagnosed with rosacea if you present with at least two of the major phenotypes.

SECONDARY PHENOTYPES: Burning or stinging, swelling (oedema) and dry appearance. These symptoms are not necessary for diagnosis and are not considered enough to form a diagnosis in isolation.

By splitting these out, it’s thought that medical practitioners will be able to tailor diagnosis, treatment, and classification with more care. They will give a more standardised criteria for research, analysing results, comparing data, as well as giving a more individual and specific diagnosis.

(If you’re still confused, this post with a handy quiz might help)

I think on a patient level, the original subtypes will continue to be used as it’s hard to completely phase out terms that have been used and understood for 17 years. But I wanted to explain these changes to prepare you, in case your doctor refers to phenotypes in an appointment. I think it’s fascinating to see the new ways in which rosacea is being understood and categorised – it’s definitely a step in the right direction. It’s also a good way to track the changes in your skin, as phenotypes can be added and removed from your diagnosis as time goes on.

In order for the new rosacea classifications of phenotypes to make it into common language used by patients, I think there might need to be some simplifying of the terminology: it’s easy for me to classify my rosacea to another sufferer by saying type 1 or type 2, whereas no one is going to say ‘I have rosacea, let me list my 7 individual phenotypes…’! I wonder if a coding system would be more user friendly, with each phenotype having a letter or number representative. E.g. ‘I have rosacea: phenotypes A234ABC’ or something similar. What do you think? Are you in the ‘if it’s not broke don’t fix it’ camp, or do you think this will help to improve diagnosis and treatment? Let me know in the comments below!

If you want to read the details for yourself, this is the link. I hope you found this blog post helpful or at least found it as interesting as I did!

Lex

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