Recommendations for rosacea diagnosis, classification and management: update from the global ROSacea COnsensus 2019 panel.

BACKGROUND: A transition from a subtyping to a phenotyping approach in rosacea is underway, allowing individual patient management according to presenting features instead of categorization by predefined subtypes. The ROSacea COnsensus (ROSCO) 2017 recommendations further support this transition and align with guidance from other working groups. OBJECTIVES: To update and extend previous global ROSCO recommendations in line with the latest research and continue supporting uptake of the phenotype approach in rosacea through clinical tool development. METHODS: Nineteen dermatologists and two ophthalmologists used a modified Delphi approach to reach consensus on statements pertaining to critical aspects of rosacea diagnosis, classification and management. Voting was electronic and blinded. RESULTS: Delphi statements on which the panel achieved consensus of ≥ 75% voting 'Agree' or 'Strongly agree' are presented. The panel recommends discussing disease burden with patients during consultations, using four questions to assist conversations. The primary treatment objective should be achievement of complete clearance, owing to previously established clinical benefits for patients. Cutaneous and ocular features are defined. Treatments have been reassessed in line with recent evidence and the prior treatment algorithm updated. Combination therapy is recommended to benefit patients with multiple features. Ongoing monitoring and dialogue should take place between physician and patients, covering defined factors to maximize outcomes. A prototype clinical tool (Rosacea Tracker) and patient case studies have been developed from consensus statements. CONCLUSIONS: The current survey updates previous recommendations as a basis for local guideline development and provides clinical tools to facilitate a phenotype approach in practice and improve rosacea patient management. What's already known about this topic? A transition to a phenotype approach in rosacea is underway and is being recommended by multiple working groups. New research has become available since the previous ROSCO consensus, necessitating an update and extension of recommendations. What does this study add? We offer updated global recommendations for clinical practice that account for recent research, to continue supporting the transition to a phenotype approach in rosacea. We present prototype clinical tools to facilitate use of the phenotype approach in practice and improve management of patients with rosacea.

Updating the diagnosis, classification and assessment of rosacea: recommendations from the global ROSacea COnsensus (ROSCO) panel.

BACKGROUND: Rosacea is currently diagnosed by consensus-defined primary and secondary features and managed by subtype. However, individual features (phenotypes) can span multiple subtypes, which has implications for clinical practice and research. Adopting a phenotype-led approach may facilitate patient-centred management. OBJECTIVES: To advance clinical practice by obtaining international consensus to establish a phenotype-led rosacea diagnosis and classification scheme with global representation. METHODS: Seventeen dermatologists and three ophthalmologists used a modified Delphi approach to reach consensus on statements pertaining to critical aspects of rosacea diagnosis, classification and severity evaluation. All voting was electronic and blinded. RESULTS: Consensus was achieved for transitioning to a phenotype-based approach to rosacea diagnosis and classification. The following two features were independently considered diagnostic for rosacea: (i) persistent, centrofacial erythema associated with periodic intensification; and (ii) phymatous changes. Flushing, telangiectasia, inflammatory lesions and ocular manifestations were not considered to be individually diagnostic. The panel reached agreement on dimensions for phenotype severity measures and established the importance of assessing the patient burden of rosacea. CONCLUSIONS: The panel recommended an approach for diagnosis and classification of rosacea based on disease phenotype.

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

BACKGROUND: Rosacea is currently treated according to subtypes. As this does not adequately address the spectrum of clinical presentation (phenotypes), it has implications for patient management. The ROSacea COnsensus 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: Seventeen dermatologists and three ophthalmologists reached consensus on critical aspects of rosacea treatment and management using a modified Delphi approach. The panel voted on statements using the responses 'strongly disagree', 'disagree', 'agree' or 'strongly agree'. Consensus was defined as ≥ 75% 'agree' or '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 skincare 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 the 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 was achieved to support this approach for rosacea treatment strategies.

[The hypertrophic scar]. / La cicatriz hipertrófica.

The authors briefly review the literature about hypertrophic scars, emphasizing the etiopathogenesis and treatments, taking in account, the good therapeutic results of pressure-treated scars.

Sarcoidosis. Un enfoque global / Sarcoidosis. A global approach

La Sarcoidosis es una enfermedad multisistémica de causa desconocida, que frecuentemente se presenta con adenopatía hiliar bilateral, infiltraciónpulmonar, lesiones cutáneas y oculares. El diagnóstico se establece cuando los hallazgos clínico-radiológicos son sustentados por una histopatologíaque evidencia granulomas no caseosos de células epitelioides.La predisposición a adquirir Sarcoidosis parece genéticamente determinada, sin embargo solo un pequeño grupo de alelos de HLA han sido posiblesde identificar, asociados a la susceptibilidad de la enfermedad.La Sarcoidosis es un síndrome que puede deberse a muchos factores precipitantes. Hay quienes piensan que solo hay un ùnico agente antigénico, aúnno determinado, que condiciona la involución o persistencia de la enfermedad, por razones que son un enigma y motivo de intensa investigación.Se describen las manifestaciones cutáneas estableciendo un ordenamiernto de las múltiples y variables lesiones. Así como también se describen lasmanifestaciones sistémicas más relevantes.Se hace referencia a las enfermedades asociadas que pueden encontrarse en la Sarcoidosis, en especial la patología autoinmune y las neoplasiashematológicas.Las alternativas terapéuticas más utilizadas son los corticoesteroides y los antipalúdicos, El metotrexato, talidomida, tetraciclinas y el infliximab tienenindicación en ciertos casos especiales (AU)

Sarcoidosis is a multisystemic disease of unknown cause that frequently appears with bilateral hiliar adenopathy, lung infiltration and skin and eyelesions.Diagnosis is made when clinical and radiological findings are backed by histopathology evidencing granulomas no caseosos of epitelial cells.Predisposition to acquire sarcoidosis seems to be genetic, however only a small group of alelos de HLA could be identified in association to disease susceptibility.Sarcoidosis is a syndrome that can obey to many precipitant factors. Some people think that there is only one antigenic agent, not identified yet, thatconditions the involution or persistence of the disease, for reasons that are an enigma and a cause of intense research.It has been described different skin manifestations settling a range of multiple and variable lesions. Even more relevant systemic manifestations havebeen described.There is a special reference of diseases associated with sarcoidosis such as autoinmune pathology and hematological neoplasias.The most used alternative therapies are cortocoesteroids and antimalarials.The methotrexate, thalidomide, tetracyclines and the infliximab are indicatedin some special cases (AU)

Alopecia areata. Correlacion con alteraciones del electroencefalograma. / Alopecia areata, Correlation with alterations of the electroencephalography

Se realizo un estudio eletroencefalografico en 108 pacientes afectados de alopecia areata en los que se encontraron trazados normales, de tension y patologicos. Los adultos presentan mas frecuentemente trazados de tension, hecho que estaria vinculado al posible origen psicosomatico de esta enfermedad