Updating the diagnosis, classification and assessment of rosacea: recommendations from the global ROSacea COnsensus (ROSCO) panel

Summary 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. Objectives 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. What's already known about this topic? Since the 2002 consensus publication from European and North American experts, rosacea diagnosis has been based largely on the presence of more than one of the following primary features: flushing, nontransient erythema, papules/pustules or telangiectasia. Secondary features are not considered diagnostic for rosacea, i.e. burning/stinging, plaque, dry appearance, oedema, peripheral location, phymatous changes and ocular manifestations. Four common presentations are grouped into subtypes, i.e. erythematotelangiectatic, inflammatory papulopustular, phymatous and ocular rosacea. What does this study add? This study re‐evaluates the primary and secondary features of rosacea in order to rationalize diagnosis and classification based on a phenotype approach. This study provides a global perspective on rosacea diagnosis and classification with representation from Africa, Asia, Europe, North America and South America. Respond to this article Linked Editorial: Drucker. Br J Dermatol 2017;