[Brady Barrows]

A report by the new ROSIE [ROSacea International Expert] Group reports that, “Classification of rosacea into stages or subgroups, with or without progression, remained controversial.” This new group is comprised of “European and US rosacea experts.” Two of the experts in the group are MAC members of the RRDi, Dr. Draelos and Dr. Jensen. The report, Rosacea – global diversity and optimized outcome: proposed international consensus from the Rosacea International Expert Group, was released by J Eur Acad Dermatol Venereol. 2010 Jun 23. [1]

This is not a new controversy. The late Albert Kligman, a noted expert on rosacea, stated in 2003 about the NRS classification of rosacea into four subtypes and one variant:

”In my view this is a vast oversimplification which will not solve the diagnostic dilemmas that confront us. I see no reason not to give equal nosologic status to granulomatous rosacea, rosacea conglobata, rosacea inversa (formerly called pyoderma faciale), rosacea fulminans, edematous rosacea (a devastating variety) or combinations with seborrheic dermatitis, lupus erythematosus, acne vulgaris, and still other variants. Reducing the classification to four sub-types does little to clarify and eliminate the inherent complexities of this mysterious disease.” [2]

Another report released after the ROSIE group report mentioned above had this remark about how a ‘proper standardization’ is needed:

“It is to be remarked that the quality of most studies evaluating rosacea treatment is rather poor, mainly due to a lack of proper standardization. For a major breakthrough to occur in the management of rosacea, we need both a better understanding of its pathogenesis and the adherence of future clinical trials to clearly defined grading and inclusion criteria, which are crucial for investigators to correctly compare and interpret the results of their work.” [3]

Could the MAC members comment on this new report by Elewski et al?

[1] Rosacea - global diversity and optimized outcome: proposed international consensus from the Rosacea International Expert Group.
Elewski BE, Draelos Z, Dréno B, Jansen T, Layton A, Picardo M.
J Eur Acad Dermatol Venereol. 2010 Jun 23

[2] A Personal Critique on the State of Knowledge of Rosacea
Albert M. Kligman, M.D., Ph.D.

[3] Rosacea Treatments: What’s New and What’s on the Horizon?
Gallo R, Drago F, Paolino S, Parodi A.
Am J Clin Dermatol. 2010;11(5):299-30

[Brady Barrows]

From: Latkany, MD Robert
Subject: RE: RRDi MAC Members Please Comment on Topic
Date: July 6, 2010 10:33:48 AM HST
To: Brady Barrows

In general I would agree. However, if dividing the type of rosacea into subtypes helps explain different etiologies then it is necessary and will be helpful to guide physicians into different treatment directions. But until we better understand why people get rosacea this is all insignificant.

Robert Latkany, MD
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[Brady Barrows]

Email from:

From:
Robert Brodell, MD
Subject: Re: Please take five minutes to comment
Date: July 21, 2010 10:52:08 AM HST
To: Barrows Brady

The best way to categorize acne rosacea would be into subgroups that are treated in the same manner......I like erythrotelangiectatic rosacea as a subset where infection is not a key issue and antibiotics might be less important than evolving vasoconstricting drugs, laser therapy and coverups. Papulopusular acne and many of the variants mentioned in the previous comment are related to demodex, bacterial infection, and pityrosporon yeast.....to the extent that most respond to antibiotics, I have always favored bacteria as a key part of the pathogenesis in most patients, though the antiinflammatory effects of antibiotics may explain their benefits as well. The subset that is associated with seborrheic dermatitis is best treated like rosacea, plus ketoconazole cream bid to cover the pityrosporon that induces seb derm. There will always be some controversy here, but this is the approach I would take if I were a thought leader!

Robert Brodell, MD