Re: Did anyone else read the latest article at Dr. Sy's site??

[Guest guest]

Is this what you're talking about, ? The first article gives a

nice summary of the new NRS classification. I hope Dr. Sy approves of

it being copy-and-pasted here:

http://www.lindasy.com/latenews.html

Standard classification of rosacea: Report of the National cea

Society Expert Committee on the Classification and Staging of cea

Committee members: J. Wilkins, MD, M. Dahl, MD, M. Detmar, MD, L.

Drake, MD, A, Feinstein, MD, R. Odom, MD & F. , MD; J Am Acad

Dermatology, April, 2002.

The National cea Society recently assembled a committee of

experts to develop a standard classification system as well as

diagnostic criteria for rosacea, a chronic skin disorder

characterized by a diversity of clinical manifestations with unknown

etiology and no histologic or serologic markers. cea is most

frequently seen in individuals with fair skin, but has also been seen

in Asians and African Americans. It occurs in both men and women and,

although it may occur at any age, the onset typically begins after

age 30. It typically involves the central face (cheeks, chin, nose

and central forehead) often with bouts of remissions and

exacerbations.

DIAGNOSTIC CRITERIA:

Primary features:

Flushing (transient erythema or redness). A history of frequent

blushing or flushing is common.

Non-transient erythema. Persistent redness of the facial skin is the

most common sign of rosacea.

Papules and pustules. Dome-shaped red papules with or without

accompanying pustules, often in crops, are typical. Nodules may

occur. Although patients may exhibit comedones, comedones should be

considered part of an acne process unrelated to rosacea.

Telangiectasia. Telangiectases are common but not necessary for a

rosacea diagnosis.

Secondary features:

Burning or stinging. Burning or stinging sensations with or without

scaling or dermatitis may occur, especially on malar (cheek) skin.

Plaque. Elevated red plaques without epidermal changes in the

surrounding skin may occur.

Dry appearance. Central facial skin may be rough and scaling so as to

resemble dry skin and suggest an eczematous dermatitis, and may often

include the coexistence of seborrheic dermatitis. This " dryness " may

be associated with burning or stinging sensations, and may be caused

by irritation rather than the disease process.

Edema. Edema may accompany or follow prolonged facial erythema or

flushing. Sometimes soft edema may last for days or be aggravated by

inflammatory changes. Solid facial edema (persisting, hard,

nonpitting edema) can occur with rosacea, usually as a sequel of the

papulopustular type, and also independently of redness, papules and

pustules, or phymatous changes.

Ocular manifestations. Ocular manifestations are common, and range

from symptoms of burning and itching to signs of conjunctival

hyperemia and lid inflammation. Styes, chalazia, and corneal damage

may occur.

Peripheral location. cea has been reported to occur in other

locations and may or may not be accompanied by facial manifestations.

Phymatous changes. Include patulous follicles, skin thickening or

fibrosis, and a bulbous appearance.

SUBTYPES OF ROSACEA:

Erythematotelangiectatic rosacea. The most common manifestation is

frequent flushing with appearance of telangiectases. Presence of

edema, burning and stinging sensations and roughness or scaling may

also be reported.

Papulopustular rosacea. Main manifestations are transient papules or

pustules with central facial (peri-oral, perinasal or periocular)

erythema. This subtype may resemble acne vulgaris, except that

comedones are absent. However, rosacea and acne can occur

concomitantly.

Phymatous rosacea. This includes thickening skin, irregular surface

nodularities and enlargement. Rhynophyma is the most common

manifestation although skin thickening can occur in other locations

(chin, cheeks, forehead or ears).

Ocular rosacea. The signs and symptoms associated with ocular rosacea

include: watery or bloodshot appearance, foreign body sensation,

burning or stinging, dryness, itching, light sensitivity, blurred

vision, telangiectases of the conjunctiva and lid margin, or lid and

periocular eythema. Meibomian gland dysfunction presenting as

chalazion or chronic staphylococcal infection (stye) are common signs

of rosacea-related ocular disease. Treatment of cutaneous rosacea

alone may be inadequate and an ophthalmologic approach may be needed.

VARIANTS OF ROSACEA:

Granulomatous rosacea: this is characterized by hard, yellow, brown

or red papules or nodules that may be severe and lead to scarring.

These lesions may be less inflammatory and may appear on relatively

normal-looking skin.

The committee did not include the following as subtypes of rosacea

but as separate entities:

cea Fulminans. Also called pyoderma faciale, this condition is

characterized by the sudden appearance of papules, pustules and

nodules with fluctuating and draining sinuses.

Steroid-induced acneiform eruption. The committee feels that this can

occur as an inflammatory response in any patient during or after

chronic corticosteroid use although the same response may also occur

in patients with rosacea.

Perioral dermatitis. The committee stated that perioral dermatitis

without the symptoms of rosacea cannot be classified as a variant of

rosacea.