Guidelines Help Standardize cea Diagnosis

[Guest guest]

Hi,

I found the article below in the June 2002 issue of Skin and Allergy

News. It may be similar to the article posted on Dr. Sy's website

http://www.lindasy.com, but in case this one has more info I thought

I'd post it here.

Take care,

Matija

Four subtypes, one variant identified

Guidelines Help Standardize cea Diagnosis

Jeff

Senior Writer

A new, standard classification system for rosacea describes four

subtypes and one variant that have features that may be found

together or independent of each other, reported an expert committee

of the National cea Society.

Primary and secondary features of rosacea were combined to create the

subtypes, said the committee, led by Dr. Wilkin of the Food

and Drug Administration, Rockville, Md. The primary features include

transient and persistent erythema, papules and pustules, and

telangiectasia, but these are often accompanied by secondary

features. Secondary features are edema, plaques, dry appearance,

ocular manifestations, phymatous changes, burning or stinging

sensations, and symptoms peripheral to the face (J. Am. Acad.

Dermatol. 46[4]:584-87, 2002).

" Our goal was to provide all physicians with a common terminology and

a common foundation on how to diagnose and classify rosacea, "

committee member Dr. Lynn Drake of Harvard Medical School, Boston,

told SKIN & ALLERGY NEWS. With such information, physicians will be

able to make quicker and better diagnoses, and in turn improve

epidemiologic statistics that will create a firmer foundation on

which to base research, she said. The subtypes and variant are

defined as follows:

Erythematotelangiectatic rosacea (subtype 1). This subtype is

defined primarily by flushing and persistent central facial erythema.

Telangiectases are common but are not essential. It is common for a

patient with this subtype to have a history of transient erythema

alone. Edema of the central face, stinging, burning, and roughness or

scaling are often present.

Papulopustular rosacea (subtype 2). This subtype may look like acne

vulgaris without comedones. Patients will have persistent central

facial erythema accompanied by transient papules and/or pustules that

can occur in the perioral, perinasal, or periocular areas. A burning

or stinging sensation also may be present. Papulopustular rosacea can

appear after or along with erythematotelangiectatic rosacea, making

any telangiectases difficult to spot until treatment has cleared the

other features.

Phymatous rosacea (subtype 3). The thickening skin, irregular

surface nodularities, and enlargement present in phymatous rosacea

most commonly develop on the nose (rhinophyma), but may occur on the

chin, forehead, cheeks, and ears. These phymatous areas may have

patulous follicles. This subtype is often observed after or in

combination with subtypes 1 or 2.

Ocular rosacea (subtype 4). Skin signs and symptoms do not have to

be present for a diagnosis of ocular rosacea, as a limited number of

studies have suggested that ocular problems may occur before

cutaneous manifestations of the disease in up to 20% of patients.

For this diagnosis, a patient's eyes should have one or more of the

following: 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 erythema. Chalazia and hordeolums may also be present.

Some patients may have corneal complications that decrease visual

acuity.

Granulomatous rosacea (variant). Patients with this variant of

rosacea have hard, yellow, brown, or red cutaneous papules or nodules

that sit upon fairly normal-looking skin of the cheeks and

periorificial areas. All of the papules and nodules on a particular

patient will have the same shape and size. Unlike the subtypes,

granulomatous rosacea can be diagnosed without the presence of other

rosacea signs.

The experts found insufficient evidence to include rosacea fulminans,

steroid-induced acneiform eruption, and perioral dermatitis as types

of rosacea.

[Guest guest]

Matija,

Do you have a link for that journal article? Thanks.

> Hi,

>

> I found the article below in the June 2002 issue of Skin and

Allergy

> News. It may be similar to the article posted on Dr. Sy's

website

> http://www.lindasy.com, but in case this one has more info I

thought

> I'd post it here.

> Take care,

> Matija

>

> Four subtypes, one variant identified

> Guidelines Help Standardize cea Diagnosis

>

> Jeff

> Senior Writer

>

>

> A new, standard classification system for rosacea describes

four

> subtypes and one variant that have features that may be found

> together or independent of each other, reported an expert

committee

> of the National cea Society.

>

> Primary and secondary features of rosacea were combined to

create the

> subtypes, said the committee, led by Dr. Wilkin of the

Food

> and Drug Administration, Rockville, Md. The primary features

include

> transient and persistent erythema, papules and pustules, and

> telangiectasia, but these are often accompanied by secondary

> features. Secondary features are edema, plaques, dry

appearance,

> ocular manifestations, phymatous changes, burning or

stinging

> sensations, and symptoms peripheral to the face (J. Am. Acad.

> Dermatol. 46[4]:584-87, 2002).

>

> " Our goal was to provide all physicians with a common

terminology and

> a common foundation on how to diagnose and classify

rosacea, "

> committee member Dr. Lynn Drake of Harvard Medical School,

Boston,

> told SKIN & ALLERGY NEWS. With such information,

physicians will be

> able to make quicker and better diagnoses, and in turn

improve

> epidemiologic statistics that will create a firmer foundation on

> which to base research, she said. The subtypes and variant

are

> defined as follows:

>

> Erythematotelangiectatic rosacea (subtype 1). This subtype is

> defined primarily by flushing and persistent central facial

erythema.

> Telangiectases are common but are not essential. It is

common for a

> patient with this subtype to have a history of transient erythema

> alone. Edema of the central face, stinging, burning, and

roughness or

> scaling are often present.

>

> Papulopustular rosacea (subtype 2). This subtype may look

like acne

> vulgaris without comedones. Patients will have persistent

central

> facial erythema accompanied by transient papules and/or

pustules that

> can occur in the perioral, perinasal, or periocular areas. A

burning

> or stinging sensation also may be present. Papulopustular

rosacea can

> appear after or along with erythematotelangiectatic rosacea,

making

> any telangiectases difficult to spot until treatment has cleared

the

> other features.

>

> Phymatous rosacea (subtype 3). The thickening skin, irregular

> surface nodularities, and enlargement present in phymatous

rosacea

> most commonly develop on the nose (rhinophyma), but may

occur on the

> chin, forehead, cheeks, and ears. These phymatous areas

may have

> patulous follicles. This subtype is often observed after or in

> combination with subtypes 1 or 2.

>

> Ocular rosacea (subtype 4). Skin signs and symptoms do not

have to

> be present for a diagnosis of ocular rosacea, as a limited

number of

> studies have suggested that ocular problems may occur

before

> cutaneous manifestations of the disease in up to 20% of

patients.

>

> For this diagnosis, a patient's eyes should have one or more of

the

> following: 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 erythema. Chalazia and hordeolums may also be

present.

> Some patients may have corneal complications that decrease

visual

> acuity.

>

> Granulomatous rosacea (variant). Patients with this variant of

> rosacea have hard, yellow, brown, or red cutaneous papules or

nodules

> that sit upon fairly normal-looking skin of the cheeks and

> periorificial areas. All of the papules and nodules on a

particular

> patient will have the same shape and size. Unlike the

subtypes,

> granulomatous rosacea can be diagnosed without the

presence of other

> rosacea signs.

>

> The experts found insufficient evidence to include rosacea

fulminans,

> steroid-induced acneiform eruption, and perioral dermatitis as

types

> of rosacea.

[Guest guest]

Matija,

Do you have a link for that journal article? Thanks.

> Hi,

>

> I found the article below in the June 2002 issue of Skin and

Allergy

> News. It may be similar to the article posted on Dr. Sy's

website

> http://www.lindasy.com, but in case this one has more info I

thought

> I'd post it here.

> Take care,

> Matija

>

> Four subtypes, one variant identified

> Guidelines Help Standardize cea Diagnosis

>

> Jeff

> Senior Writer

>

>

> A new, standard classification system for rosacea describes

four

> subtypes and one variant that have features that may be found

> together or independent of each other, reported an expert

committee

> of the National cea Society.

>

> Primary and secondary features of rosacea were combined to

create the

> subtypes, said the committee, led by Dr. Wilkin of the

Food

> and Drug Administration, Rockville, Md. The primary features

include

> transient and persistent erythema, papules and pustules, and

> telangiectasia, but these are often accompanied by secondary

> features. Secondary features are edema, plaques, dry

appearance,

> ocular manifestations, phymatous changes, burning or

stinging

> sensations, and symptoms peripheral to the face (J. Am. Acad.

> Dermatol. 46[4]:584-87, 2002).

>

> " Our goal was to provide all physicians with a common

terminology and

> a common foundation on how to diagnose and classify

rosacea, "

> committee member Dr. Lynn Drake of Harvard Medical School,

Boston,

> told SKIN & ALLERGY NEWS. With such information,

physicians will be

> able to make quicker and better diagnoses, and in turn

improve

> epidemiologic statistics that will create a firmer foundation on

> which to base research, she said. The subtypes and variant

are

> defined as follows:

>

> Erythematotelangiectatic rosacea (subtype 1). This subtype is

> defined primarily by flushing and persistent central facial

erythema.

> Telangiectases are common but are not essential. It is

common for a

> patient with this subtype to have a history of transient erythema

> alone. Edema of the central face, stinging, burning, and

roughness or

> scaling are often present.

>

> Papulopustular rosacea (subtype 2). This subtype may look

like acne

> vulgaris without comedones. Patients will have persistent

central

> facial erythema accompanied by transient papules and/or

pustules that

> can occur in the perioral, perinasal, or periocular areas. A

burning

> or stinging sensation also may be present. Papulopustular

rosacea can

> appear after or along with erythematotelangiectatic rosacea,

making

> any telangiectases difficult to spot until treatment has cleared

the

> other features.

>

> Phymatous rosacea (subtype 3). The thickening skin, irregular

> surface nodularities, and enlargement present in phymatous

rosacea

> most commonly develop on the nose (rhinophyma), but may

occur on the

> chin, forehead, cheeks, and ears. These phymatous areas

may have

> patulous follicles. This subtype is often observed after or in

> combination with subtypes 1 or 2.

>

> Ocular rosacea (subtype 4). Skin signs and symptoms do not

have to

> be present for a diagnosis of ocular rosacea, as a limited

number of

> studies have suggested that ocular problems may occur

before

> cutaneous manifestations of the disease in up to 20% of

patients.

>

> For this diagnosis, a patient's eyes should have one or more of

the

> following: 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 erythema. Chalazia and hordeolums may also be

present.

> Some patients may have corneal complications that decrease

visual

> acuity.

>

> Granulomatous rosacea (variant). Patients with this variant of

> rosacea have hard, yellow, brown, or red cutaneous papules or

nodules

> that sit upon fairly normal-looking skin of the cheeks and

> periorificial areas. All of the papules and nodules on a

particular

> patient will have the same shape and size. Unlike the

subtypes,

> granulomatous rosacea can be diagnosed without the

presence of other

> rosacea signs.

>

> The experts found insufficient evidence to include rosacea

fulminans,

> steroid-induced acneiform eruption, and perioral dermatitis as

types

> of rosacea.

[Guest guest]

Hi,

I found the article below at http://www.eskinandallergynews.com You

have to register to read the articles, but registration is free.

About the entire journal article, several of us have wanted to get

our hands on it. Unfortunately, J. Am. Acad. Dermatol. is a journal

sponsored by the AMA. They don't seem to want to place the entire

article online.

I live in a city with a medical school, but it's a bit of a hike with

public transportation from where I work and live. As well, parking is

atrocious. They do let civilians like myself photocopy journal

articles. Does anyone live near a medical school where you can go to

the library and do this? Or perhaps someone is a student at a

university or college where there is an affiliated medical school. If

you want to photocopy the article and send it to me to be scanned,

I'll be happy to upload the article to the group.

Take care,

Matija

> > Hi,

> >

> > I found the article below in the June 2002 issue of Skin and

> Allergy

> > News. It may be similar to the article posted on Dr. Sy's

> website

> > http://www.lindasy.com, but in case this one has more info I

> thought

> > I'd post it here.

> > Take care,

> > Matija

> >

> > Four subtypes, one variant identified

> > Guidelines Help Standardize cea Diagnosis

> >

> > Jeff

> > Senior Writer

> >

> >

> > A new, standard classification system for rosacea describes

> four

> > subtypes and one variant that have features that may be found

> > together or independent of each other, reported an expert

> committee

> > of the National cea Society.

> >

> > Primary and secondary features of rosacea were combined to

> create the

> > subtypes, said the committee, led by Dr. Wilkin of the

> Food

> > and Drug Administration, Rockville, Md. The primary features

> include

> > transient and persistent erythema, papules and pustules, and

> > telangiectasia, but these are often accompanied by secondary

> > features. Secondary features are edema, plaques, dry

> appearance,

> > ocular manifestations, phymatous changes, burning or

> stinging

> > sensations, and symptoms peripheral to the face (J. Am. Acad.

> > Dermatol. 46[4]:584-87, 2002).

> >

> > " Our goal was to provide all physicians with a common

> terminology and

> > a common foundation on how to diagnose and classify

> rosacea, "

> > committee member Dr. Lynn Drake of Harvard Medical School,

> Boston,

> > told SKIN & ALLERGY NEWS. With such information,

> physicians will be

> > able to make quicker and better diagnoses, and in turn

> improve

> > epidemiologic statistics that will create a firmer foundation on

> > which to base research, she said. The subtypes and variant

> are

> > defined as follows:

> >

> > Erythematotelangiectatic rosacea (subtype 1). This subtype is

> > defined primarily by flushing and persistent central facial

> erythema.

> > Telangiectases are common but are not essential. It is

> common for a

> > patient with this subtype to have a history of transient erythema

> > alone. Edema of the central face, stinging, burning, and

> roughness or

> > scaling are often present.

> >

> > Papulopustular rosacea (subtype 2). This subtype may look

> like acne

> > vulgaris without comedones. Patients will have persistent

> central

> > facial erythema accompanied by transient papules and/or

> pustules that

> > can occur in the perioral, perinasal, or periocular areas. A

> burning

> > or stinging sensation also may be present. Papulopustular

> rosacea can

> > appear after or along with erythematotelangiectatic rosacea,

> making

> > any telangiectases difficult to spot until treatment has cleared

> the

> > other features.

> >

> > Phymatous rosacea (subtype 3). The thickening skin, irregular

> > surface nodularities, and enlargement present in phymatous

> rosacea

> > most commonly develop on the nose (rhinophyma), but may

> occur on the

> > chin, forehead, cheeks, and ears. These phymatous areas

> may have

> > patulous follicles. This subtype is often observed after or in

> > combination with subtypes 1 or 2.

> >

> > Ocular rosacea (subtype 4). Skin signs and symptoms do not

> have to

> > be present for a diagnosis of ocular rosacea, as a limited

> number of

> > studies have suggested that ocular problems may occur

> before

> > cutaneous manifestations of the disease in up to 20% of

> patients.

> >

> > For this diagnosis, a patient's eyes should have one or more of

> the

> > following: 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 erythema. Chalazia and hordeolums may also be

> present.

> > Some patients may have corneal complications that decrease

> visual

> > acuity.

> >

> > Granulomatous rosacea (variant). Patients with this variant of

> > rosacea have hard, yellow, brown, or red cutaneous papules or

> nodules

> > that sit upon fairly normal-looking skin of the cheeks and

> > periorificial areas. All of the papules and nodules on a

> particular

> > patient will have the same shape and size. Unlike the

> subtypes,

> > granulomatous rosacea can be diagnosed without the

> presence of other

> > rosacea signs.

> >

> > The experts found insufficient evidence to include rosacea

> fulminans,

> > steroid-induced acneiform eruption, and perioral dermatitis as

> types

> > of rosacea.

[Guest guest]

Ooops, I don't want to do that then. Thanks for the suggestion about

contacting the publisher.

Take care,

Matija

> > If you want to photocopy the article and send it to me to be

> > scanned, I'll be happy to upload the article to the group.

>

> Matija, that's not legal. The article is copyright protected, so it

> can't be distributed to the public without prior approval from the

> publisher. Individual copies can be xeroxed if they are for

> educational purposes only, which is why a person can xerox the

> article in a medical library. But even that xeroed copy cannot then

> be publicly distributed.

>

> Why don't you email the publishers and ask permission? It's

certainly

> a reasonable request, esp if its posted in a members only access

> area.

>

> Marjorie

>

> Marjorie Lazoff, MD

[Guest guest]

Ooops, I don't want to do that then. Thanks for the suggestion about

contacting the publisher.

Take care,

Matija

> > If you want to photocopy the article and send it to me to be

> > scanned, I'll be happy to upload the article to the group.

>

> Matija, that's not legal. The article is copyright protected, so it

> can't be distributed to the public without prior approval from the

> publisher. Individual copies can be xeroxed if they are for

> educational purposes only, which is why a person can xerox the

> article in a medical library. But even that xeroed copy cannot then

> be publicly distributed.

>

> Why don't you email the publishers and ask permission? It's

certainly

> a reasonable request, esp if its posted in a members only access

> area.

>

> Marjorie

>

> Marjorie Lazoff, MD

[Guest guest]

Ooops, I don't want to do that then. Thanks for the suggestion about

contacting the publisher.

Take care,

Matija

> > If you want to photocopy the article and send it to me to be

> > scanned, I'll be happy to upload the article to the group.

>

> Matija, that's not legal. The article is copyright protected, so it

> can't be distributed to the public without prior approval from the

> publisher. Individual copies can be xeroxed if they are for

> educational purposes only, which is why a person can xerox the

> article in a medical library. But even that xeroed copy cannot then

> be publicly distributed.

>

> Why don't you email the publishers and ask permission? It's

certainly

> a reasonable request, esp if its posted in a members only access

> area.

>

> Marjorie

>

> Marjorie Lazoff, MD