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Affiliation(s)
- C Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, U.K
| | - K Abuabara
- Program for Clinical Research, Department of Dermatology, University of California San Francisco (UCSF), CA, U.S.A
| | - F Bath-Hextall
- Centre for Evidence Based Healthcare, School of Health Sciences, University of Nottingham, Nottingham, U.K
| | - A Nast
- Division of Evidence based Medicine (dEBM), Department of Dermatology, Venerology und Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - E van Zuuren
- Dermatology Department, Leiden University Medical Centre, Leiden, the Netherlands
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Schaller M, Almeida LMC, Bewley A, Cribier B, Dlova NC, Kautz G, Mannis M, Oon HH, Rajagopalan M, Steinhoff M, Thiboutot D, Troielli P, Webster G, Wu Y, van Zuuren E, Tan J. Rosacea treatment update: recommendations from the global ROSacea COnsensus (ROSCO) panel. Br J Dermatol 2017; 176:465-471. [PMID: 27861741 DOI: 10.1111/bjd.15173] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 01/15/2023]
Abstract
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.
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Affiliation(s)
- M Schaller
- Department of Dermatology, Universitatsklinikum Tubingen, Tubingen, Baden-Württemberg, Germany
| | - L M C Almeida
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - A Bewley
- Whipps Cross University Hospital, London, U.K.,Royal London Hospital, London, U.K
| | - B Cribier
- Department of Dermatology, Hopitaux Universitaires de Strasbourg, Strasbourg, Alsace, France
| | - N C Dlova
- Department of Dermatology, University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
| | - G Kautz
- Haut- und Laserklinik, Konz, Germany
| | - M Mannis
- Department of Ophthalmology and Vision Science, University of California Davis, Davis, CA, U.S.A
| | - H H Oon
- National Skin Centre, Singapore
| | - M Rajagopalan
- Apollo Hospitals Enterprise, Chennai, Tamil Nadu, India
| | - M Steinhoff
- Department of Dermatology and UCD Charles Institute for Translational Dermatology, University College Dublin, Dublin, Ireland
| | - D Thiboutot
- Department of Dermatology, Pennsylvania State University College of Medicine, Hershey, PA, U.S.A
| | - P Troielli
- Faculty of Dermatology, Universidad de Buenos Aires, School of Medicine, Buenos Aires, Argentina
| | - G Webster
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, U.S.A
| | - Y Wu
- Department of Dermatology, Peking University First Hospital, Beijing, China
| | - E van Zuuren
- Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - J Tan
- Department of Medicine, University of Western Ontario, Windsor, ON, Canada
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Peters AA, van Dorst E, Jellis B, van Zuuren E, Hermans J, Trimbos JB. A randomized clinical trial to compare two different approaches in women with chronic pelvic pain. Obstet Gynecol 1991; 77:740-4. [PMID: 1826544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
One hundred six patients with chronic pelvic pain were randomly allocated to one of two treatment groups. In the standard-approach group, organic causes of pelvic pain were excluded first and diagnostic laparoscopy was routinely performed. If no somatic cause could be found, attention was given to other causes such as psychological disturbances. In the second group an integrated approach was chosen. From the beginning equal attention was devoted to somatic, psychological, dietary, environmental, and physiotherapeutic factors. In this group, laparoscopy was not routinely performed. Both groups were similar with respect to clinical characteristics of the patients and the severity of their pain as assessed by various pain parameters. Postcoital pain was reported by 27% of the patients. Twenty percent of the patients had had negative sexual experiences such as childhood sexual abuse or rape. Evaluation of the pain 1 year after the institution of treatment revealed that the integrated approach improved pelvic pain significantly more often than the standard approach for three out of four pain parameters (P less than .01). Laparoscopy played no important role in the treatment of pelvic pain. It is concluded that equal attention to both organic and other causative factors from the beginning of therapy is more likely to result in a reduction of pelvic pain than is a standard approach.
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Affiliation(s)
- A A Peters
- Department of Gynecology, Leiden University Medical Center, The Netherlands
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