Rosacea treatment update: Recommendations from the global ROSacea COnsensus (ROSCO) panel

Summary

Background

Rosacea is currently treated according to subtypes. As this does not adequately address the patient spectrum of clinical presentation (phenotypes), it has implications for patient management. The ROSacea COnsensus (ROSCO) panel was established to address this issue.

Objectives

To incorporate current best treatment evidence with clinical experience from an international expert panel and establish consensus to improve outcomes for patients with rosacea.

Methods

17 dermatologists and three ophthalmologists reached consensus on critical aspects of rosacea treatment and management by a modified Delphi approach by voting on statements: strongly disagree, disagree, agree or strongly agree (consensus ≥75% agree/strongly agree). All voting was electronic and blinded.

Results

The panel agreed on phenotype-based treatments for signs and symptoms presenting in individuals with rosacea. First-line treatments were identified for individual major features of transient and persistent erythema, inflammatory papules/pustules, telangiectasia and phyma, underpinned by general skin care measures. Multiple features in an individual patient can be simultaneously treated with multiple agents. If treatment is inadequate given appropriate duration, another first-line option or addition of another first-line agent should be considered. Maintenance treatment depends on treatment modality and patient preferences. Ophthalmological referral for all but the mildest ocular features should be considered. Lid hygiene and artificial tears in addition to medications are used to treat ocular rosacea.

Conclusions

Rosacea diagnosis and treatment should be based on clinical presentation. Consensus is shown for treatment strategies to support this approach.

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