While a host of conditions can cause symptoms that may superficially resemble rosacea, dermatologists are increasingly able to pinpoint this widespread disorder and any concurrent conditions in order to tailor appropriate therapy for the individual patient. Proper diagnosis of rosacea can be especially important, since treatments for similar-appearing conditions can often make rosacea worse.
Rosacea usually begins as a flushing or redness on the cheeks, nose, chin or forehead. Left untreated, the redness tends to grow more permanent, and small dilated blood vessels may become visible on the skin. Bumps and pimples called papules and pustules also commonly appear, and in advanced cases the nose may grow swollen from excess tissue.
How do dermatologists differentiate rosacea from other facial skin disorders? "In dermatology, it's what you see and where you see it," said Dr. Joseph Bikowski, assistant clinical professor of dermatology at the University of Pittsburgh. "The pattern of distribution, the color and size of any bumps and other skin characteristics are usually enough to alert a dermatologist."
He noted that some of the conditions that may superficially resemble rosacea include acne vulgaris, folliculitis, perioral dermatitis, contact or seborrheic dermatitis and lupus erythematosus.1
For instance, bumps and pimples characterize acne vulgaris, the condition perhaps most often mistaken for rosacea, according to Dr. Bikowski. A condition called Pityrosporum folliculitis also produces papules and pustules, and an inflammatory disorder known as lupus erythematosus produces redness, scales and a butterfly-shaped rash across the central portion of the face -- all possible signs of rosacea.
However, each of these conditions also has telltale differences from rosacea. For example, in acne, the bumps and pimples may appear over the entire face rather than the central portion, there is no history of flushing and symptoms also include whiteheads or blackheads, called comedones, which do not appear in rosacea.
Furthermore, contact dermatitis -- an allergic reaction to an external agent like poison ivy -- is intensely itchy, unlike rosacea. Lupus erythematosus is scaly, in contrast to rosacea, and includes macules -- flat areas of redness of the skin.
However, sometimes another skin disorder appearing at the same time as rosacea can complicate the diagnosis, said Dr. Jonathan Weiss, assistant clinical professor of dermatology at Emory University School of Medicine.
For example, a rosacea patient with dry, scaly skin may be difficult to distinguish from one with scaling from seborrheic dermatitis, he said, and the two sometimes appear together.
To receive treatment that is appropriate for your specific condition or concurrent conditions, it is critical to consult a dermatologist, who can prescribe therapy targeted to your individual skin problems and also ensure that medication to help alleviate one condition does not make another disorder worse.
For example, since topical steroid therapy often used for seborrheic dermatitis can trigger or exacerbate rosacea symptoms, Dr. Weiss recommends using nonsteroidal therapy when these two conditions occur simultaneously.
In the vast majority of patients, the diagnosis of rosacea is clear to a dermatologist, Dr. Weiss said. "Usually, there is very little doubt that a patient has rosacea," he said.
- Garver JH, Wilkin JK: Flushing and Rosacea: Overview and Nursing Interventions. Dermatology Nursing. 1992;4:271-277