Phenotype Approach to Rosacea May Help Improve Diagnosis, Classification

In order to enhance the understanding of the diagnosis and classification of rosacea, facilitate treatment decisions, and ultimately improve patient care, progression from the use of a subtype approach to a phenotype approach in patients with the disease is now recommended, according to the results of a review published in the British Journal of Dermatology.¹

The investigators sought to offer practical recommendations that will enable adoption of a phenotype approach for rosacea to practice and research.

Although several working groups are currently aligned with the use of a more patient-centric phenotype approach to rosacea based on a patient’s presenting signs and symptoms, the use of subtyping is still commonplace across the field. An integrated approach is thus required to ensure widespread progression to a phenotype approach in rosacea.

Challenges associated with implementation of a phenotype approach include poor support and organization within the healthcare system; lack of resources, time, knowledge, and awareness; and hesitancy about implementing new recommendations.²  

Inconsistent nomenclature — namely the varied use and definitions of “rosacea” and “acne rosacea” — persist in the literature, highlighting the need for improved differentiation by phenotype in trials.  

The researchers recommended several actions be taken in order to improve the assessment of disease severity and impact on quality of life:

• Updating the language surrounding the diagnosis and classification to discontinue the concept of subtyping
• Initiating an international meeting of stakeholders in order to develop a communications plan for the phenotype concept
• Educating patients and healthcare professionals in order to raise awareness and improve understanding of the phenotype nomenclature
• Demonstrating the clinical value of switching to phenotyping and reinforcing the shortcomings of the subtyping approach
• Developing simple clinical tools for physicians to use that  are applicable to all types of skin pigment

The investigators concluded that although the transition from a subtype approach to a phenotype approach to rosacea is underway, significant work is still needed in order to ensure a comprehensive update.

Reference

1. Tan J, Berg M, Gallo RL, Del Rosso JQ. Applying the phenotype approach for rosacea to practice and research [published online May 25, 2018]. Br J Dermatol. 
2. doi:10.1111/bjd.16815
3. Fitzgerald A, Lethaby A. Providing consultancy and research in health economics for the NHS, pharmaceutical and health care industries since 1986. NICE Review of Systematic Reviews Exploring the Implementation/Uptake of Guidelines. Published March 2014. www.nice.org.uk/guidance/ph56/evidence/evidence-review-2-431762366. Accessed May 25, 2018.