New developments aid diagnosis

Kissimmee, Fla. - With the recent development of the Rosacea classification and grading systems, Lynn Annette Drake, M.D. of Boston, emphasized the importance of these systems in the diagnosis and treatment of rosacea.

Dr. Drake presented, "Rosacea and differential diagnosis; new developments in rosacea" at the Orlando Dermatology and Cosmetic Conference here.

"As a whole dermatologists are recognizing rosacea and identifying it far more frequently and so are patients," Dr. Drake says. "We needed a means by which we could talk about this disease, so the National Rosacea Society sponsored panels of experts to come up with a new classification for rosacea and a grading system. This allowed us to begin using standard terminology to describe the disease in order to have a common foundation. We hope this will advance the understanding of the disease as well as how we discuss it.

"This new system is not the final word. It was simply to provide a "baseline" or a starting point as we begin to think more about this disease," Dr. Drake explains. "The classification may be modified and I expect it to be modified, actually. The same with the grading system, but at least we will be modifying it from a common base."

Pathophysiology The pathophysiology of rosacea remains relatively unknown, however, development of this new classification and grading system will hopefully provide practitioners with a basis for dialogue.

"Many practitioners feel that rosacea is predominately a vascular disorder but there are some that feel that it has a strong follicular component and others think it is mixed. In fact everybody may be right but no one has broken it down to define it utilizing various categories," Dr. Drake says. "The treatment of the vascular form of rosacea would likely differ from rosacea that was purely follicular, and the treatment of combination disease would have a different approach all together," Dr. Drake says.

Rosacea is a poorly understood disease, and in order to further understanding, practitioners need to speak the same language.

"What is clearly important is defining and evaluating published research using common terminology so there is an understanding among specialists," Dr. Drake says.

Impact Dr. Drake says that avoiding triggers of rosacea as well as using the appropriate medications are equally important. "The approach to treatment should be targeted to what the patient actually has. It has been my experience that each patient is different," Dr. Drake says.

Dermatologists should also understand the benefits and toxicities associated with certain approaches to treatment.

"For example there are drugs that cause vasoconstriction so it is important to avoid rebound vasodilatation," she says. "Potent topical steroids should be avoided in the treatment of rosacea because although there is an initial vasoconstriction, there is vascular vasodilatation as a rebound phenomenon. Although they may be helpful in the short term, in the long term they can actually cause trouble."

Dr. Drake suggests having patients keep a two-week diary of their symptoms to gain insight into the triggers and mechanisms of their rosacea.

"Having patients keep a diary is important, as each patient's rosacea differs slightly. The diary can be utilized to help practitioners diagnose and treat an individual patient. If a patient will keep a detailed two-week dairy, the practitioner can frequently identify the factors that aggravate or trigger the patient's Rosacea," Dr. Drake says.

Impact on the dermatologist As for the practicing dermatologist, the new classification and grading system will provide practitioners with clarification and guidelines for the diagnosis, treatment and further research into the disease. It will also help practitioners treat patients more effectively.