Validation and Responsiveness of the Rosacea Area and Severity Index in a Chinese Cohort: A Comparative Study with the Investigator’s Global Assessment

Authors

  • Yukun Wang Department of Dermatology & Venerology, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China https://orcid.org/0000-0001-6304-9379
  • Hongjie Luo Department of Dermatology & Venerology, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China https://orcid.org/0009-0003-1936-7718
  • Deyu Song Department of Dermatology & Venerology, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
  • Xinjin Liu Department of Dermatology & Venerology, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
  • Yuanting Wang Department of Dermatology & Venerology, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
  • Yingying Dai Department of Dermatology & Venerology, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
  • Xucheng Zhou Department of Dermatology & Venerology, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
  • Hui Li Department of Dermatology & Venerology, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
  • Xian Jiang Department of Dermatology & Venerology, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China

DOI:

https://doi.org/10.2340/actadv.v106.adv-2026-0599

Keywords:

rosacea, severity assessment, Rosacea Area and Severity Index, Investigator’s Global Assessment

Abstract

The Rosacea Area and Severity Index (RASI) is a recently developed tool for assessing rosacea severity, but its validation has so far been limited, requiring further independent evaluation. This study aimed to comprehensively assess the reliability, validity and responsiveness of the RASI in a Chinese cohort. Six trained observers independently evaluated standardized photographs of 230 Chinese patients with rosacea using both the RASI and the Investigator’s Global Assessment (IGA). Round 1 assessment was used to determine interobserver reliability and convergent validity, while a subgroup of 60 patients was reassessed to evaluate intraobserver reliability and responsiveness (Round 2). In this subgroup, baseline and 1-month follow-up photographs were rescored after 3 months by the same observers. Results showed moderateto-strong correlations between RASI and IGA at baseline, supporting validity. Interobserver reliability was high for both RASI and IGA overall scores, with intraclass correlation coefficients of 0.923 and 0.935. Intraobserver reliability showed no significant deviation (p>0.05). For responsiveness, RASI demonstrated a higher standardized response mean than IGA (0.43 vs 0.37) with a similar effect size. Additionally, RASI detected statistically significant changes (p<0.001) in patients classified as “stable” by IGA. Overall, RASI showed robust reliability, validity and superior responsiveness

Downloads

Download data is not yet available.

References

Tan J, Almeida LMC, Bewley A, Cribier B, Dlova NC, Gallo R, et al. Updating the diagnosis, classification and assessment of rosacea: recommendations from the global ROSacea COnsensus (ROSCO) panel. Br J Dermatol 2017; 176: 431–438. DOI: https://doi.org/10.1111/bjd.15122

Schaller M, Almeida LMC, Bewley A, Cribier B, Del Rosso J, Dlova NC, et al. Recommendations for rosacea diagnosis, classification and management: update from the global ROSacea COnsensus 2019 panel. Br J Dermatol 2020; 182: 1269–1276. DOI: https://doi.org/10.1111/bjd.18420

Del Rosso JQ, Tanghetti E, Webster G, Stein Gold L, Thiboutot D, Gallo RL. Update on the management of rosacea from the American Acne & Rosacea Society (AARS). J Clin Aesthet Dermatol 2020; 13: S17–S24.

Gether L, Overgaard LK, Egeberg A, Thyssen JP. Incidence and prevalence of rosacea: a systematic review and meta-analysis. Br J Dermatol 2018; 179: 282–289. DOI: https://doi.org/10.1111/bjd.16481

Ma G, Zhang Y, Gao Q, Yuan X, Zhou Z, Jian D, et al. Gabapentin improves the flushing of rosacea, but not other rosacea symptoms or quality of life: Results from a multicenter, randomized, double-blind, placebo-controlled pilot study. J Am Acad Dermatol 2025; 92: 920–922. DOI: https://doi.org/10.1016/j.jaad.2024.12.003

Hopkinson D, Moradi Tuchayi S, Alinia H, Feldman SR. Assessment of rosacea severity: a review of evaluation methods used in clinical trials. J Am Acad Dermatol 2015; 73: 138–143. DOI: https://doi.org/10.1016/j.jaad.2015.02.1121

Wienholtz NKF, Thyssen JP, Christensen CE, Thomsen SF, Karmisholt KE, Jemec GBE, et al. Validity and reliability of the Rosacea Area and Severity Index: a novel scoring system for clinical assessment of rosacea severity. J Eur Acad Dermatol Venereol 2023; 37: 573–580. DOI: https://doi.org/10.1111/jdv.18721

Mattei PL, Corey KC, Kimball AB. Psoriasis Area Severity Index (PASI) and the Dermatology Life Quality Index (DLQI): the correlation between disease severity and psychological burden in patients treated with biological therapies. J Eur Acad Dermatol Venereol 2014; 28: 333–337. DOI: https://doi.org/10.1111/jdv.12106

Jacobson ME, Morimoto RY, Leshem YA, Howells L, Williams HC, Grinich E, et al. The Eczema Area and Severity Index: an update of progress and challenges in its measurement of atopic dermatitis after 20 years of use. J Eur Acad Dermatol Venereol 2025; 39: 70–85. DOI: https://doi.org/10.1111/jdv.20248

Alexis AF, Callender VD, Baldwin HE, Desai SR, Rendon MI, Taylor SC. Global epidemiology and clinical spectrum of rosacea, highlighting skin of color: review and clinical practice experience. J Am Acad Dermatol 2019; 80: 1722–1729. DOI: https://doi.org/10.1016/j.jaad.2018.08.049

Taylor SC. Skin of color: biology, structure, function, and implications for dermatologic disease. J Am Acad Dermatol 2002; 46: S41–62. DOI: https://doi.org/10.1067/mjd.2002.120790

Berardesca E, Maibach H. Racial differences in skin pathophysiology. J Am Acad Dermatol 1996; 34: 667–672. DOI: https://doi.org/10.1016/S0190-9622(96)80070-3

Goh CF. Diversity of Asian skin: a review on skin biophysical properties. Exp Dermatol 2024; 33: e14959. DOI: https://doi.org/10.1111/exd.14959

Gomez-Lara AR, Zakaria A, Sanchez-Anguiano ME, Amerson EH. Rosacea prevalence, severity, and phenotype by race, ethnicity, and gender: a cross-sectional study of a diverse patient cohort within a primary care population. JAAD Int 2026; 24: 338–341. DOI: https://doi.org/10.1016/j.jdin.2025.11.016

Pan Y, Jia K, Yan S, Jiang X. Effectiveness of VISIA system in evaluating the severity of rosacea. Skin Res Technol 2022; 28: 740–748. DOI: https://doi.org/10.1111/srt.13194

Sedaghat AR. Understanding the Minimal Clinically Important Difference (MCID) of patient-reported outcome measures. Otolaryngol Head Neck Surg 2019; 161: 551–560. DOI: https://doi.org/10.1177/0194599819852604

Downloads

Additional Files

Published

2026-06-29

How to Cite

Wang, Y., Luo, H., Song, D., Liu, X., Wang, Y., Dai, Y., … Jiang, X. (2026). Validation and Responsiveness of the Rosacea Area and Severity Index in a Chinese Cohort: A Comparative Study with the Investigator’s Global Assessment. Acta Dermato-Venereologica, 106, adv–2026. https://doi.org/10.2340/actadv.v106.adv-2026-0599

Issue

Vol. 106 (2026)

Section

Articles

Categories

License

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.

Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.

Crossref
Scopus
Google Scholar
Europe PMC