title: Rosacea treatment update: recommendations from the global ROSacea COnsensus (ROSCO) panel.
abstract: BACKGROUND
  Rosacea is currently treated according to subtypes. As this does not adequately address the spectrum of clinical presentation (phenotypes), it has implications for patient management. The ROSacea COnsensus panel was established to address this issue.
  
  
  OBJECTIVE
  To incorporate current best treatment evidence with clinical experience from an international expert panel and establish consensus to improve outcomes for patients with rosacea.
  
  
  METHODS
  Seventeen dermatologists and three ophthalmologists reached consensus on critical aspects of rosacea treatment and management using a modified Delphi approach. The panel voted on statements using the responses 'strongly disagree', 'disagree', 'agree' or 'strongly agree'. Consensus was defined as ≥ 75% 'agree' or 'strongly agree'. All voting was electronic and blinded.
  
  
  RESULTS
  The panel agreed on phenotype-based treatments for signs and symptoms presenting in individuals with rosacea. First-line treatments were identified for individual major features of transient and persistent erythema, inflammatory papules/pustules, telangiectasia and phyma, underpinned by general skincare measures. Multiple features in an individual patient can be simultaneously treated with multiple agents. If treatment is inadequate given appropriate duration, another first-line option or the addition of another first-line agent should be considered. Maintenance treatment depends on treatment modality and patient preferences. Ophthalmological referral for all but the mildest ocular features should be considered. Lid hygiene and artificial tears in addition to medications are used to treat ocular rosacea.
  
  
  CONCLUSIONS
  Rosacea diagnosis and treatment should be based on clinical presentation. Consensus was achieved to support this approach for rosacea treatment strategies.
authors.affiliation: Department of Dermatology, Universitatsklinikum Tubingen, Tubingen, Baden-Württemberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schaller
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: 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.
authors.forename: H H
authors.initials: HH
authors.lastname: Oon
authors.affiliation: 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, Universidad de Buenos Aires, School of Medicine, 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
authors.initials: E
authors.lastname: van Zuuren
authors.affiliation: Department of Medicine, University of Western Ontario, Windsor, ON, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Tan
mesh_terms: D000465:Algorithms; D032921:Consensus; D000068937:Cosmeceuticals / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005128:Eye Diseases / Q000188:drug therapy; D006801:Humans; D012393:Rosacea / Q000188:drug therapy*; D017592:Skin Care / Q000379:methods; D013473:Sunscreening Agents / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000068937:Cosmeceuticals; D003879:Dermatologic Agents; D013473:Sunscreening Agents