Based on the consensus statements of an expert panel held in 2019, the British Journal of Dermatology published updated recommendations for rosacea diagnosis, classification, and treatment.

The global Rosacea Consensus (ROSCO) project comprises a panel of dermatologists and ophthalmologists from Africa, Asia, Europe, North America, and South America. The 2019 ROSCO panel included 19 dermatologists and 2 ophthalmologists. The modified Delphi approach was used to reach consensus on statements regarding the clinical management of rosacea. Six e-surveys were distributed to clinicians, with a group virtual meeting conducted to allow resolution of disagreements. Voting was electronic and blinded. Delphi statements on which at least 75% of the panel voted “agree” or “strongly agree” were presented as the primary ROSCO 2019 recommendations.

Discussing disease burden with patients during consultations was recommended by 19 of 21 panel members. The Dermatology Life Quality Index was endorsed (81%), and 4 alternative questions on quality of life were recommended for clinical use. Complete clearance was identified as the primary treatment objective by 20 clinicians. The 2017 ROSCO treatment algorithm was updated on the basis of new clinical evidence. Specifically, topical alpha-adrenergic modulating agents and oral beta blockers were removed as treatment for flushing/transient erythema; topical alpha-adrenergic modulating agents, intense pulsed light, and vascular lasers were added as treatment options for persistent centrofacial erythema; and combination therapy was endorsed as an option for patients with severe rosacea or patients with multiple rosacea features. All panel members agreed that rosacea management necessitates ongoing monitoring and communication between patient and physician. Both cutaneous and ocular features were defined, with ocular rosacea diagnosis identified as an unmet need in the patient population. Per the consensus statements from this current ROSCO project, a prototype clinical tool (Rosacea Tracker) was developed. Rosacea Tracker comprises a clinical checklist and is intended to monitor rosacea features and treatment response over time.

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The primary limitation of the ROSCO model is the use of clinical opinion rather than published evidence to develop recommendations. However, literature on clinical management of rosacea is limited, and the Delphi model is a well-validated, egalitarian method for developing clinical guidelines. “These recommendations can provide a basis for local guideline development and help to improve outcomes in all patients with rosacea by individualising management,” the authors wrote.

Disclosure: This clinical trial was supported by Galderma. Please see the original reference for a full list of authors’ disclosures.


Schaller M, Almeida LMC, Bewley A, et al. Recommendations for rosacea diagnosis, classification and management: Update from the global ROSacea COnsensus (ROSCO) 2019 panel [published online August 7, 2019]. Br J Dermatol. doi: 10.1111/bjd.18420

This article originally appeared on Dermatology Advisor