S2k guidelines for rosacea: Phenotype-based classification for diagnosis and therapy

17.03.2022 16:59

Redness and visible veins on the face, papules and pustules, inflammation of the eyes and eyelids: the symptoms of rosacea, a widespread chronic inflammatory skin disease, are easily recognizable and are often a burden for those affected due to the aesthetic component. The S2k guideline for rosacea from the German Dermatological Society (DDG) explains the new symptom-oriented classification according to phenotypes and explains how rosacea differs from other dermatoses such as. B. Acne is differentiated and what drug, surgical and photomedical treatment options are available. A focus of the guideline is on eye involvement (ocular rosacea) and the role of psychosocial aspects. The guideline also includes advice on skin and body care for patients.

Rosacea is a chronic inflammatory, non-contagious skin disease. There are no exact figures on frequency. Estimates suggest that around two to five percent of the population in Germany are affected. Rosacea usually occurs in middle age and is characterized by permanent redness or paroxysmal redness (flushing) and visible blood vessels (telangiectasia).

Papules, pustules and swelling can also occur. The dermatosis occurs on the cheeks, chin, forehead and nose, and more rarely on the scalp, neck or chest area. While the symptoms can initially be easily influenced therapeutically, the attacks become more severe over time for some patients. The eyes can also be affected. “Rosacea is a complex dermatosis whose previous subtype classification is obsolete,” emphasizes the guideline coordinator Dr. medical Dr. re. biol. hum. Benjamin Clanner-Engelshofen. The new S2k guidelines recommend a symptom-oriented classification according to phenotypes. “This is the basis for individualized diagnostics and therapy,” says Clanner-Engelshofen, dermatologist at the Clinic and Polyclinic for Dermatology and Allergology, LMU Munich. The guideline presents the many special forms of rosacea and numerous differential diagnoses, including the diagnostic options for differentiation.

The now published S2k guideline for rosacea expands on the previous recommendations. For example, the chapter on eye involvement is new. “Ocular rosacea affects 50 percent of patients. The guidelines provide concrete information on drug therapy, but also – aimed at those affected – tips for good eyelid margin hygiene,” says Clanner-Engelshofen. Chapter by chapter, the guideline authors describe and discuss in detail all treatment options, taking into account the current study situation: topical therapy, systemic therapy, combined therapy, alternative therapies (PDT, laser, IPL, surgery), therapy of special forms, therapy of ocular rosacea and dermocosmetic measures .

In addition to the German Ophthalmological Society and the Society for Dermopharmacy, the German Rosacea Hilfe e. V. involved. “Involving patient organizations in the guideline work is important and is also reflected in the fact that we have included a separate chapter on psychosocial aspects that have previously received less attention,” explains Clanner-Engelshofen. The skin symptoms associated with rosacea can lead to stigmatization of those affected, cause anxiety and depression and thus reduce the quality of life.

Another chapter is dedicated to dermocosmetics. Here patients can find out how they can help their skin dermocosmetically. The skin should be cleansed gently, for example with lukewarm water and pH-neutral washing substances. “Anything that irritates the skin, such as strong rubbing, peelings and substances that promote blood circulation, should be avoided,” emphasizes Clanner-Engelshofen. Cosmetics with active ingredients to improve the symptoms and daily use of broad-spectrum sun protection are also recommended.

The new S2k guidelines are not only aimed at dermatologists, but also contain many important recommendations for doctors in related disciplines. “We would be pleased if this guideline were taken into account, especially in general medicine and ophthalmology,” says Professor Dr. medical Michael Hertl, President of the German Dermatological Society (DDG), together.

To the rosacea guideline, which is available on the DDG website Download is also available from the Commission for Quality Assurance in Dermatology Guideline implementation assistance appeared in the form of a short presentation.

Literature:

S2k guideline “Rosacea” (AWMF registration number 013-065). 2022.