Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Jun 1;158(6):617-625.
doi: 10.1001/jamadermatol.2022.0526.

Assessment of Frequency of Rosacea Subtypes in Patients With Rosacea: A Systematic Review and Meta-analysis

Yousef A Barakji  1 , Amalie Thorsti Møller Rønnstad  1 , Maria O Christensen  1 , Claus Zachariae  1 , Nita K F Wienholtz  1 , Anne-Sofie Halling  2 , Julia-Tatjana Maul  3 , Simon F Thomsen  1 , Alexander Egeberg  1 , Jacob P Thyssen  1
Affiliations
Meta-Analysis

Assessment of Frequency of Rosacea Subtypes in Patients With Rosacea: A Systematic Review and Meta-analysis

Yousef A Barakji et al. JAMA Dermatol. .

Abstract

Importance: Four distinct rosacea subtypes have traditionally been recognized, but the frequency of these subtypes among patients with rosacea remains unknown.

Objective: To assess the frequency of 4 rosacea subtypes.

Data sources: This systemic review and meta-analysis included a search of 2 databases, PubMed and Embase, from inception of the databases to November 2, 2021. The search was filtered to include only studies of human participants published in English, French, and German.

Study selection: Studies were screened independently by 2 of the authors and were included if they were original with a sample size of 25 or more patients and reported absolute numbers or frequency of patients affected by rosacea subtypes. Studies that did not report sufficient data to calculate the proportions of subtypes were excluded.

Data extraction and synthesis: Data extraction was performed independently and in duplicate by 2 of the authors, using the search term rosacea, according to the Preferred Reporting items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search term, objectives, and study protocol methods were defined before the study was initiated. A total of 292 studies were included for full-text assessment. Owing to the heterogeneity of the included studies, a random-effects model was used.

Main outcome and measures: The main outcome was the proportion of patients with rosacea in each of the 4 major subtype groups defined by the 2002 National Rosacea Society classification system. Measures were absolute numbers or frequency of patients affected by each of the 4 rosacea subtypes.

Results: A total of 39 studies examining 9190 patients with rosacea were included. The pooled proportion of erythematotelangiectatic rosacea was 56.7% (95% CI, 51.4%-62.0%), of papulopustular rosacea was 43.2% (95% CI, 38.8%-47.6%), of phymatous rosacea was 7.4% (95% CI, 6.1%-8.9%), and of ocular rosacea was 11.1% (95% CI, 6.7%-16.3%). Subtype distribution occurred equally among men and women except for phymatous rosacea, which was more prevalent in men. Studies from Africa showed the lowest proportion of erythematotelangiectatic rosacea. Differences in frequency of subtypes were observed when stratification by publication year was performed.

Conclusion and relevance: In this systematic review and meta-analysis, differences were found in rosacea subtypes by patient sex and by continent of origin and publication year of included studies. Erythematotelangiectatic and papulopustular rosacea were the most prevalent subtypes, but data should be interpreted with caution. Future studies should use the phenotype-based rosacea approach.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Halling-Overgaard reported receiving personal fees from Leo Pharma and Coloplast outside the submitted work. Dr Thomsen reported receiving grants from Novartis, AbbVie, UCB, Sanofi, and Janssen outside the submitted work. Dr Egeberg reported receiving research funding from Pfizer, Eli Lilly, Novartis, Bristol-Myers Squibb, AbbVie, Janssen Pharmaceuticals, the Danish National Psoriasis Foundation, the Simon Spies Foundation, and the Kgl Hofbundtmager Aage Bang Foundation and honoraria as consultant and/or speaker from AbbVie, Almirall, Leo Pharma, Zuellig Pharma Ltd, Galápagos NV, Sun Pharmaceuticals, Samsung Bioepis Co, Ltd, Pfizer, Eli Lilly and Company, Novartis, Union Therapeutics, Galderma, Dermavant, UCB, Mylan, Bristol-Myers Squibb, and Janssen Pharmaceuticals outside the submitted work. Dr Thyssen reported receiving personal fees from Regeneron, Leo Pharma, Lilly, AbbVie, Almirall, Sanofi Genzyme, Pfizer, Asana, Arena, and OM-85 outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. PRISMA Flow Diagram
Figure 2.
Figure 2.. Forest Plot Showing Pooled Proportion of ETR
Proportion meta-analysis plot (random effect) showing the proportion of ETR. I2 = 95.9%. ETR indicates erythematotelangiectatic rosacea.
Figure 3.
Figure 3.. Forest Plot Showing Pooled Proportion of PPR
Proportion meta-analysis plot (random effect) showing the proportion of PPR. I2 = 94.0%. PPR indicates papulopustular rosacea.
Figure 4.
Figure 4.. Forest Plot Showing Pooled Proportion of PhR
Proportion meta-analysis plot (random effect) showing the proportion of PhR. I2 = 81.4%. PhR indicates phymatous rosacea.
Figure 5.
Figure 5.. Forest Plot Showing Pooled Proportion of Ocular Rosacea
Proportion meta-analysis plot (random effect) showing the proportion of ocular rosacea. I2 = 98.1%.
See this image and copyright information in PMC

References

    1. van Zuuren EJ, Fedorowicz Z, Carter B, van der Linden MM, Charland L. Interventions for rosacea. Cochrane Database Syst Rev. 2015;2015(4):CD003262. - PMC - PubMed
    1. Oge’ LK, Muncie HL, Phillips-Savoy AR. Rosacea: diagnosis and treatment. Am Fam Physician. 2015;92(3):187-196. - PubMed
    1. Gether L, Overgaard LK, Egeberg A, Thyssen JP. Incidence and prevalence of rosacea: a systematic review and meta-analysis. Br J Dermatol. 2018;179(2):282-289. doi: 10.1111/bjd.16481 - DOI - PubMed
    1. Elewski BE, Draelos Z, Dréno B, Jansen T, Layton A, Picardo M. Rosacea - global diversity and optimized outcome: proposed international consensus from the Rosacea International Expert Group. J Eur Acad Dermatol Venereol. 2011;25(2):188-200. doi: 10.1111/j.1468-3083.2010.03751.x - DOI - PubMed
    1. Wilkin J, Dahl M, Detmar M, et al. Standard classification of rosacea: report of the National Rosacea Society Expert Committee on the Classification and Staging of Rosacea. J Am Acad Dermatol. 2002;46(4):584-587. doi: 10.1067/mjd.2002.120625 - DOI - PubMed