title: Updating the diagnosis, classification and assessment of rosacea: recommendations from the global ROSacea COnsensus (ROSCO) panel.
abstract: BACKGROUND
  Rosacea is currently diagnosed by consensus-defined primary and secondary features and managed by subtype. However, individual features (phenotypes) can span multiple subtypes, which has implications for clinical practice and research. Adopting a phenotype-led approach may facilitate patient-centred management.
  
  
  OBJECTIVE
  To advance clinical practice by obtaining international consensus to establish a phenotype-led rosacea diagnosis and classification scheme with global representation.
  
  
  METHODS
  Seventeen dermatologists and three ophthalmologists used a modified Delphi approach to reach consensus on statements pertaining to critical aspects of rosacea diagnosis, classification and severity evaluation. All voting was electronic and blinded.
  
  
  RESULTS
  Consensus was achieved for transitioning to a phenotype-based approach to rosacea diagnosis and classification. The following two features were independently considered diagnostic for rosacea: (i) persistent, centrofacial erythema associated with periodic intensification; and (ii) phymatous changes. Flushing, telangiectasia, inflammatory lesions and ocular manifestations were not considered to be individually diagnostic. The panel reached agreement on dimensions for phenotype severity measures and established the importance of assessing the patient burden of rosacea.
  
  
  CONCLUSIONS
  The panel recommended an approach for diagnosis and classification of rosacea based on disease phenotype.
authors.affiliation: Department of Medicine, University of Western Ontario, Windsor, ON, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Tan
authors.affiliation: Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: L M C
authors.initials: LM
authors.lastname: Almeida
authors.affiliation: Whipps Cross University Hospital, London, U.K.|Royal London Hospital, London, U.K.
authors.forename: A
authors.initials: A
authors.lastname: Bewley
authors.affiliation: Department of Dermatology, Hopitaux Universitaires de Strasbourg, Strasbourg, Alsace, France.
authors.forename: B
authors.initials: B
authors.lastname: Cribier
authors.affiliation: Department of Dermatology, University of KwaZulu-Natal College of Health Sciences, Durban, South Africa.
authors.forename: N C
authors.initials: NC
authors.lastname: Dlova
authors.affiliation: Department of Dermatology, University of California San Diego, La Jolla, CA, U.S.A.
authors.forename: R
authors.initials: R
authors.lastname: Gallo
authors.affiliation: Haut- und Laserklinik, Konz, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Kautz
authors.affiliation: Department of Ophthalmology and Vision Science, University of California Davis, Davis, CA, U.S.A.
authors.forename: M
authors.initials: M
authors.lastname: Mannis
authors.affiliation: National Skin Centre, Singapore, Singapore.
authors.forename: H H
authors.initials: HH
authors.lastname: Oon
authors.affiliation: Department of Dermatology, Apollo Hospitals Enterprise, Chennai, Tamil Nadu, India.
authors.forename: M
authors.initials: M
authors.lastname: Rajagopalan
authors.affiliation: Department of Dermatology and UCD Charles Institute for Translational Dermatology, University College Dublin, Dublin, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: Steinhoff
authors.affiliation: Department of Dermatology, Pennsylvania State University College of Medicine, Hershey, PA, U.S.A.
authors.forename: D
authors.initials: D
authors.lastname: Thiboutot
authors.affiliation: Faculty of Dermatology, School of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina.
authors.forename: P
authors.initials: P
authors.lastname: Troielli
authors.affiliation: Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, U.S.A.
authors.forename: G
authors.initials: G
authors.lastname: Webster
authors.affiliation: Department of Dermatology, Peking University First Hospital, Beijing, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: E J
authors.initials: EJ
authors.lastname: van Zuuren
authors.affiliation: Department of Dermatology, Universitatsklinikum Tubingen, Tubingen, Baden-Württemberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schaller
mesh_terms: D017668:Age of Onset; D032921:Consensus; D017281:Cost of Illness; D003872:Dermatitis / Q000209:etiology; D000072085:Dermatologists; D005128:Eye Diseases / Q000145:classification / Q000175:diagnosis*; D006801:Humans; D007391:International Cooperation; D008019:Life Style; D000072163:Ophthalmologists; D010347:Patient Care Planning; D012393:Rosacea / Q000145:classification / Q000175:diagnosis*; D012720:Severity of Illness Index; D012880:Skin Pigmentation / Q000502:physiology; D013684:Telangiectasis / Q000209:etiology