Differential Diagnosis for Rosacea: Key Considerations for Clinicians

Rosacea is a prevalent chronic inflammatory skin condition characterized by a complex and not fully understood pathophysiology. It’s believed that an amplified immune response along with neuroimmune and neurovascular changes are central to its development.¹ The disease follows a relapsing and remitting course, with varying symptoms appearing at different times.² Often underdiagnosed, rosacea is estimated to affect between 2% and 10% of adults.^2,3 This article aims to assist clinicians in the crucial task of rosacea recognition and its Differential Diagnosis For Rosacea, distinguishing it from other dermatological conditions presenting with similar signs and symptoms.

Recognizing Rosacea: Identifying the Typical Patient Profile

Facial redness and persistent erythema are considered hallmark signs of rosacea, appearing alone or with a combination of other symptoms (Figure 1).^4,5 Rosacea is frequently initially diagnosed in individuals between 30 and 60 years of age. Women are reportedly two to three times more likely to be affected than men.^6,7 However, men may experience more severe symptoms, particularly phymatous changes like rhinophyma.² While rosacea is most commonly observed in fair-skinned individuals of Northern European descent, it can affect people of all ethnicities and skin types.^6,8-10

Key signs and symptoms of rosacea prominently involve the central face, including telangiectasias, papules, pustules, and persistent or intermittent facial edema.^8,11 Patients might report uncomfortable flushing, a transient erythema, which can be accompanied by sensations of stinging, burning, or itching, possibly extending down the neck and chest.¹⁰ Rosacea symptoms often fluctuate and occur independently, highlighting the importance of a symptom-focused management approach.¹²

Ocular involvement is significant, affecting up to 50% of rosacea patients, with equal prevalence in men and women. Ocular rosacea typically manifests as inflammatory conjunctivitis, with or without blepharitis.⁶ Patients may describe a gritty feeling, itchy, burning, or dry eyes; lid erythema or swelling may also be present. Chronic ocular rosacea can lead to corneal neovascularization and keratitis, potentially resulting in corneal scarring and even perforation.¹³ It’s important to note that the severity of skin and eye symptoms are not correlated, and ocular rosacea can occur even without skin manifestations.^8,10 Dermatologists experienced in treating diverse skin types recognize that while rosacea may be less common in individuals with skin of color, it is certainly not rare (Figure 2).¹⁴ Factors potentially contributing to a

Facial Erythema and Telangiectasia in Rosacea

Differential diagnosis for rosacea is crucial for effective management. Conditions such as acne vulgaris, seborrheic dermatitis, lupus erythematosus, and perioral dermatitis can mimic rosacea. A careful clinical examination, considering the patient’s history, symptom presentation, and distribution of lesions, is essential to differentiate rosacea from these and other dermatologic conditions. Recognizing the typical rosacea patient and understanding the range of its clinical manifestations are the first steps in accurate diagnosis and appropriate treatment strategies.

References

1. [Original Article Reference – if available, otherwise remove]
2. [Original Article Reference – if available, otherwise remove]
3. [Original Article Reference – if available, otherwise remove]
4. [Original Article Reference – if available, otherwise remove]
5. [Original Article Reference – if available, otherwise remove]
6. [Original Article Reference – if available, otherwise remove]
7. [Original Article Reference – if available, otherwise remove]
8. [Original Article Reference – if available, otherwise remove]
9. [Original Article Reference – if available, otherwise remove]
10. [Original Article Reference – if available, otherwise remove]
11. [Original Article Reference – if available, otherwise remove]
12. [Original Article Reference – if available, otherwise remove]
13. [Original Article Reference – if available, otherwise remove]