New Classification of cea by NRS

[Guest guest]

Hi,

I wanted to post this article from the Dermatology Times because I

believe it describes the classification that was printed recently in

the Journal of American Academic Dermatology that Marjorie told us

about a few weeks back. (Wilkin J, Dahl M, Detmar M, et al.

Standard classification of rosacea: Report of the National cea

Society Expert Committee on the Classification and Staging of cea.

J Am Acad Dermatol (United States), Apr 2002, 46(4) p584-7)

Here's it is:

September 1, 2001

By: Cheryl Guttman

Dermatology Times

National cea Society develops new standard classification system

Washington - A new standard classification system for rosacea has

been developed with the intent of providing an instrument that can be

useful to researchers, practitioners, third-party payers, and

patients alike, K. Wilkin, M.D., said at a National cea

Foundation-sponsored symposium held during the annual meeting of the

Society for Investigative Dermatology.

" The system has multiple utilities. It could facilitate

standardization of clinical research study design and analysis and

allow a more fair comparison of data from different sources. In

addition, it may serve as a diagnostic reference in clinical practice

and introduce standard terminology to enhance clear communication in

the medical setting, whether that involves researchers, clinicians,

insurance carriers, patients, or the general public, said Dr. Wilkin,

chairman, National cea Society Expert Committee on the

Classification and Staging of cea responsible for the development

of the new system. Working with Dr. Wilkin were Mark Dahl, M.D.,

Detmar, M.D., Lynn Drake, M.D., Alvan Feinstein, M.D.,

Odom, M.D., and , M.D.

In developing the system, the committee members considered existing

scientific knowledge about rosacea and its morphologic

characteristics, while trying to avoid conclusive assumptions

regarding pathogenesis and progression. Dr. Wilkin emphasized,

however, that the committee considers the system " provisional. "

" This system is an investigational instrument providing a framework,

but we recognize it is likely to require modification, and it can be

updated and expanded as knowledge increases. Final revisions will be

made to the draft and our hope is to publish the document in a

journal so that it can be reviewed and used. The committee will be

welcoming feedback with reports on the utility and limitations of the

criteria the system sets forth along with constructive solutions, "

said Dr. Wilkin, director, division of dermatologic and dental drug

products, U.S. Food and Drug Administration, Rockville, Md. He

clarified during the meeting that development of the classification

system is independent of the FDA and the material it contains does

not represent FDA viewpoint.

System specifics

The classification system provides a definition of rosacea, describes

its general characteristics and diagnostic criteria, divides rosacea

into four subtypes, and lists several entities considered as

diagnostic exclusions.

As defined by the standard classification system, rosacea is a

chronic cutaneous disorder, primarily of the central face. It is

often characterized by remission and exacerbation and it encompasses

various combinations of such cutaneous signs as flush, erythema,

telangiectasias, edema, papules, pustules, ocular lesions, and

rhinophyma. Primary features considered as necessary for diagnosis

include flushing, erythema, papules, pustules, and telangiectasias. A

variety of secondary features are listed that may be absent or

present as a single finding or in any combination.

The system divides rosacea into four subtypes:

erythematotelangiectatic, papulopustular, phymatous, and ocular. As

presently worded, papulopustular rosacea is noted as often being

observed following or with erythematotelangiectatic disease and

phymatous rosacea as following or occurring together with either

erythematotelangiectatic or papulopustular rosacea. However, Dr.

Wilkin emphasized that while those descriptions are consistent with

common concepts about rosacea natural history, they are provisional

and subject to change.

" Most textbooks and literature citations characterize rosacea as a

disease that gradually evolves from early to later subtypes. However,

there is not conclusive evidence to substantiate that course and we

want to know if it really occurs. Nevertheless, the individual

features within a subtype can get worse, so early treatment is

advocated, even if there is not progression from one stage to the

next, " he noted.

In its current iteration, the classification system excludes rosacea

fulminans, steroid-induced acneiform eruptions, and perioral

dermatitis without rosacea signs from the diagnosis of rosacea.

" One motivation in developing this system was to introduce standard

diagnostic criteria for rosacea for use in research studies. For that

reason, it was reasonable to exclude these particular disorders.

However, in listing these exclusions, it is not the intent of the

committee to stand on a soapbox and state conclusively that they are

not rosacea. In fact, they may be variants, and with further research

we may become convinced of that, " said Dr. Dahl, professor and

chairman, department of dermatology, Mayo Clinic, sdale, Ariz.

DT

[Guest guest]

Thanks for finding this, Matija. Too bad the original report is not

available online.

Marjorie

> Hi,

>

> I wanted to post this article from the Dermatology Times because I

> believe it describes the classification that was printed recently

in

> the Journal of American Academic Dermatology that Marjorie told us

> about a few weeks back. (Wilkin J, Dahl M, Detmar M, et al.

> Standard classification of rosacea: Report of the National cea

> Society Expert Committee on the Classification and Staging of

cea.

> J Am Acad Dermatol (United States), Apr 2002, 46(4) p584-7)

>

> Here's it is:

>

> September 1, 2001

> By: Cheryl Guttman

> Dermatology Times

>

> National cea Society develops new standard classification

system

>

>

>

> Washington - A new standard classification system for rosacea has

> been developed with the intent of providing an instrument that can

be

> useful to researchers, practitioners, third-party payers, and

> patients alike, K. Wilkin, M.D., said at a National

cea

> Foundation-sponsored symposium held during the annual meeting of

the

> Society for Investigative Dermatology.

>

> " The system has multiple utilities. It could facilitate

> standardization of clinical research study design and analysis and

> allow a more fair comparison of data from different sources. In

> addition, it may serve as a diagnostic reference in clinical

practice

> and introduce standard terminology to enhance clear communication

in

> the medical setting, whether that involves researchers, clinicians,

> insurance carriers, patients, or the general public, said Dr.

Wilkin,

> chairman, National cea Society Expert Committee on the

> Classification and Staging of cea responsible for the

development

> of the new system. Working with Dr. Wilkin were Mark Dahl, M.D.,

> Detmar, M.D., Lynn Drake, M.D., Alvan Feinstein, M.D.,

> Odom, M.D., and , M.D.

>

> In developing the system, the committee members considered existing

> scientific knowledge about rosacea and its morphologic

> characteristics, while trying to avoid conclusive assumptions

> regarding pathogenesis and progression. Dr. Wilkin emphasized,

> however, that the committee considers the system " provisional. "

>

> " This system is an investigational instrument providing a

framework,

> but we recognize it is likely to require modification, and it can

be

> updated and expanded as knowledge increases. Final revisions will

be

> made to the draft and our hope is to publish the document in a

> journal so that it can be reviewed and used. The committee will be

> welcoming feedback with reports on the utility and limitations of

the

> criteria the system sets forth along with constructive solutions, "

> said Dr. Wilkin, director, division of dermatologic and dental drug

> products, U.S. Food and Drug Administration, Rockville, Md. He

> clarified during the meeting that development of the classification

> system is independent of the FDA and the material it contains does

> not represent FDA viewpoint.

>

> System specifics

>

> The classification system provides a definition of rosacea,

describes

> its general characteristics and diagnostic criteria, divides

rosacea

> into four subtypes, and lists several entities considered as

> diagnostic exclusions.

>

> As defined by the standard classification system, rosacea is a

> chronic cutaneous disorder, primarily of the central face. It is

> often characterized by remission and exacerbation and it

encompasses

> various combinations of such cutaneous signs as flush, erythema,

> telangiectasias, edema, papules, pustules, ocular lesions, and

> rhinophyma. Primary features considered as necessary for diagnosis

> include flushing, erythema, papules, pustules, and telangiectasias.

A

> variety of secondary features are listed that may be absent or

> present as a single finding or in any combination.

>

> The system divides rosacea into four subtypes:

> erythematotelangiectatic, papulopustular, phymatous, and ocular. As

> presently worded, papulopustular rosacea is noted as often being

> observed following or with erythematotelangiectatic disease and

> phymatous rosacea as following or occurring together with either

> erythematotelangiectatic or papulopustular rosacea. However, Dr.

> Wilkin emphasized that while those descriptions are consistent with

> common concepts about rosacea natural history, they are provisional

> and subject to change.

>

> " Most textbooks and literature citations characterize rosacea as a

> disease that gradually evolves from early to later subtypes.

However,

> there is not conclusive evidence to substantiate that course and we

> want to know if it really occurs. Nevertheless, the individual

> features within a subtype can get worse, so early treatment is

> advocated, even if there is not progression from one stage to the

> next, " he noted.

>

> In its current iteration, the classification system excludes

rosacea

> fulminans, steroid-induced acneiform eruptions, and perioral

> dermatitis without rosacea signs from the diagnosis of rosacea.

>

> " One motivation in developing this system was to introduce standard

> diagnostic criteria for rosacea for use in research studies. For

that

> reason, it was reasonable to exclude these particular disorders.

> However, in listing these exclusions, it is not the intent of the

> committee to stand on a soapbox and state conclusively that they

are

> not rosacea. In fact, they may be variants, and with further

research

> we may become convinced of that, " said Dr. Dahl, professor and

> chairman, department of dermatology, Mayo Clinic, sdale, Ariz.

> DT

[Guest guest]

Thanks for finding this, Matija. Too bad the original report is not

available online.

Marjorie

> Hi,

>

> I wanted to post this article from the Dermatology Times because I

> believe it describes the classification that was printed recently

in

> the Journal of American Academic Dermatology that Marjorie told us

> about a few weeks back. (Wilkin J, Dahl M, Detmar M, et al.

> Standard classification of rosacea: Report of the National cea

> Society Expert Committee on the Classification and Staging of

cea.

> J Am Acad Dermatol (United States), Apr 2002, 46(4) p584-7)

>

> Here's it is:

>

> September 1, 2001

> By: Cheryl Guttman

> Dermatology Times

>

> National cea Society develops new standard classification

system

>

>

>

> Washington - A new standard classification system for rosacea has

> been developed with the intent of providing an instrument that can

be

> useful to researchers, practitioners, third-party payers, and

> patients alike, K. Wilkin, M.D., said at a National

cea

> Foundation-sponsored symposium held during the annual meeting of

the

> Society for Investigative Dermatology.

>

> " The system has multiple utilities. It could facilitate

> standardization of clinical research study design and analysis and

> allow a more fair comparison of data from different sources. In

> addition, it may serve as a diagnostic reference in clinical

practice

> and introduce standard terminology to enhance clear communication

in

> the medical setting, whether that involves researchers, clinicians,

> insurance carriers, patients, or the general public, said Dr.

Wilkin,

> chairman, National cea Society Expert Committee on the

> Classification and Staging of cea responsible for the

development

> of the new system. Working with Dr. Wilkin were Mark Dahl, M.D.,

> Detmar, M.D., Lynn Drake, M.D., Alvan Feinstein, M.D.,

> Odom, M.D., and , M.D.

>

> In developing the system, the committee members considered existing

> scientific knowledge about rosacea and its morphologic

> characteristics, while trying to avoid conclusive assumptions

> regarding pathogenesis and progression. Dr. Wilkin emphasized,

> however, that the committee considers the system " provisional. "

>

> " This system is an investigational instrument providing a

framework,

> but we recognize it is likely to require modification, and it can

be

> updated and expanded as knowledge increases. Final revisions will

be

> made to the draft and our hope is to publish the document in a

> journal so that it can be reviewed and used. The committee will be

> welcoming feedback with reports on the utility and limitations of

the

> criteria the system sets forth along with constructive solutions, "

> said Dr. Wilkin, director, division of dermatologic and dental drug

> products, U.S. Food and Drug Administration, Rockville, Md. He

> clarified during the meeting that development of the classification

> system is independent of the FDA and the material it contains does

> not represent FDA viewpoint.

>

> System specifics

>

> The classification system provides a definition of rosacea,

describes

> its general characteristics and diagnostic criteria, divides

rosacea

> into four subtypes, and lists several entities considered as

> diagnostic exclusions.

>

> As defined by the standard classification system, rosacea is a

> chronic cutaneous disorder, primarily of the central face. It is

> often characterized by remission and exacerbation and it

encompasses

> various combinations of such cutaneous signs as flush, erythema,

> telangiectasias, edema, papules, pustules, ocular lesions, and

> rhinophyma. Primary features considered as necessary for diagnosis

> include flushing, erythema, papules, pustules, and telangiectasias.

A

> variety of secondary features are listed that may be absent or

> present as a single finding or in any combination.

>

> The system divides rosacea into four subtypes:

> erythematotelangiectatic, papulopustular, phymatous, and ocular. As

> presently worded, papulopustular rosacea is noted as often being

> observed following or with erythematotelangiectatic disease and

> phymatous rosacea as following or occurring together with either

> erythematotelangiectatic or papulopustular rosacea. However, Dr.

> Wilkin emphasized that while those descriptions are consistent with

> common concepts about rosacea natural history, they are provisional

> and subject to change.

>

> " Most textbooks and literature citations characterize rosacea as a

> disease that gradually evolves from early to later subtypes.

However,

> there is not conclusive evidence to substantiate that course and we

> want to know if it really occurs. Nevertheless, the individual

> features within a subtype can get worse, so early treatment is

> advocated, even if there is not progression from one stage to the

> next, " he noted.

>

> In its current iteration, the classification system excludes

rosacea

> fulminans, steroid-induced acneiform eruptions, and perioral

> dermatitis without rosacea signs from the diagnosis of rosacea.

>

> " One motivation in developing this system was to introduce standard

> diagnostic criteria for rosacea for use in research studies. For

that

> reason, it was reasonable to exclude these particular disorders.

> However, in listing these exclusions, it is not the intent of the

> committee to stand on a soapbox and state conclusively that they

are

> not rosacea. In fact, they may be variants, and with further

research

> we may become convinced of that, " said Dr. Dahl, professor and

> chairman, department of dermatology, Mayo Clinic, sdale, Ariz.

> DT

[Guest guest]

Thanks for finding this, Matija. Too bad the original report is not

available online.

Marjorie

> Hi,

>

> I wanted to post this article from the Dermatology Times because I

> believe it describes the classification that was printed recently

in

> the Journal of American Academic Dermatology that Marjorie told us

> about a few weeks back. (Wilkin J, Dahl M, Detmar M, et al.

> Standard classification of rosacea: Report of the National cea

> Society Expert Committee on the Classification and Staging of

cea.

> J Am Acad Dermatol (United States), Apr 2002, 46(4) p584-7)

>

> Here's it is:

>

> September 1, 2001

> By: Cheryl Guttman

> Dermatology Times

>

> National cea Society develops new standard classification

system

>

>

>

> Washington - A new standard classification system for rosacea has

> been developed with the intent of providing an instrument that can

be

> useful to researchers, practitioners, third-party payers, and

> patients alike, K. Wilkin, M.D., said at a National

cea

> Foundation-sponsored symposium held during the annual meeting of

the

> Society for Investigative Dermatology.

>

> " The system has multiple utilities. It could facilitate

> standardization of clinical research study design and analysis and

> allow a more fair comparison of data from different sources. In

> addition, it may serve as a diagnostic reference in clinical

practice

> and introduce standard terminology to enhance clear communication

in

> the medical setting, whether that involves researchers, clinicians,

> insurance carriers, patients, or the general public, said Dr.

Wilkin,

> chairman, National cea Society Expert Committee on the

> Classification and Staging of cea responsible for the

development

> of the new system. Working with Dr. Wilkin were Mark Dahl, M.D.,

> Detmar, M.D., Lynn Drake, M.D., Alvan Feinstein, M.D.,

> Odom, M.D., and , M.D.

>

> In developing the system, the committee members considered existing

> scientific knowledge about rosacea and its morphologic

> characteristics, while trying to avoid conclusive assumptions

> regarding pathogenesis and progression. Dr. Wilkin emphasized,

> however, that the committee considers the system " provisional. "

>

> " This system is an investigational instrument providing a

framework,

> but we recognize it is likely to require modification, and it can

be

> updated and expanded as knowledge increases. Final revisions will

be

> made to the draft and our hope is to publish the document in a

> journal so that it can be reviewed and used. The committee will be

> welcoming feedback with reports on the utility and limitations of

the

> criteria the system sets forth along with constructive solutions, "

> said Dr. Wilkin, director, division of dermatologic and dental drug

> products, U.S. Food and Drug Administration, Rockville, Md. He

> clarified during the meeting that development of the classification

> system is independent of the FDA and the material it contains does

> not represent FDA viewpoint.

>

> System specifics

>

> The classification system provides a definition of rosacea,

describes

> its general characteristics and diagnostic criteria, divides

rosacea

> into four subtypes, and lists several entities considered as

> diagnostic exclusions.

>

> As defined by the standard classification system, rosacea is a

> chronic cutaneous disorder, primarily of the central face. It is

> often characterized by remission and exacerbation and it

encompasses

> various combinations of such cutaneous signs as flush, erythema,

> telangiectasias, edema, papules, pustules, ocular lesions, and

> rhinophyma. Primary features considered as necessary for diagnosis

> include flushing, erythema, papules, pustules, and telangiectasias.

A

> variety of secondary features are listed that may be absent or

> present as a single finding or in any combination.

>

> The system divides rosacea into four subtypes:

> erythematotelangiectatic, papulopustular, phymatous, and ocular. As

> presently worded, papulopustular rosacea is noted as often being

> observed following or with erythematotelangiectatic disease and

> phymatous rosacea as following or occurring together with either

> erythematotelangiectatic or papulopustular rosacea. However, Dr.

> Wilkin emphasized that while those descriptions are consistent with

> common concepts about rosacea natural history, they are provisional

> and subject to change.

>

> " Most textbooks and literature citations characterize rosacea as a

> disease that gradually evolves from early to later subtypes.

However,

> there is not conclusive evidence to substantiate that course and we

> want to know if it really occurs. Nevertheless, the individual

> features within a subtype can get worse, so early treatment is

> advocated, even if there is not progression from one stage to the

> next, " he noted.

>

> In its current iteration, the classification system excludes

rosacea

> fulminans, steroid-induced acneiform eruptions, and perioral

> dermatitis without rosacea signs from the diagnosis of rosacea.

>

> " One motivation in developing this system was to introduce standard

> diagnostic criteria for rosacea for use in research studies. For

that

> reason, it was reasonable to exclude these particular disorders.

> However, in listing these exclusions, it is not the intent of the

> committee to stand on a soapbox and state conclusively that they

are

> not rosacea. In fact, they may be variants, and with further

research

> we may become convinced of that, " said Dr. Dahl, professor and

> chairman, department of dermatology, Mayo Clinic, sdale, Ariz.

> DT