Rosacea Diagnosis

Patients may be diagnosed with rosacea who have a combination of signs & symptoms which may or may not be specific to this disease. Therefore, when diagnosing rosacea other diseases should also be considered:

• acne
• contact dermatitis
• eczema
• lupus
• sarcoidosis

As there are also variants of this disease such as ocular rosacea (which affects the eyes), a standard classification system has been developed by the United States National Rosacea Society to aid correct diagnosis.

The classification system uses diagnostic criteria which assesses both primary & secondary features (signs & symptoms) of rosacea.

Primary Features: the presence of one or more of these features is indicative of rosacea.

• flushing - (transient erythema)
• persistent redness of the face - (non transient erythema)
• bumps & pimples - (papules & pustules)
• visible blood vessels - (telangiectasia)

Secondary Features: a person with rosacea may also experience any of the following features
- in some cases they may occur independently

• burning or stinging
• plaques - raised red patches of skin
• dry appearance to the skin
• swelling - edema
• eye irritation - e.g. burning or itching of the eyes, inflammation of the eye lid
• affected areas beyond the face - features of rosacea can also occur on other areas including the neck chest scalp & ears.
• skin thickening - phymatous changes such as rhinophyma

Subtypes Of Rosacea

When making a diagnosis, combinations of the signs and symptoms listed above can be compared to those features which characterize a particular subtype of rosacea.

Subtype 1: Erythematotelangiectatic rosacea

Characterized by

• flushing
• persistent central facial erythema - reddening of the skin due to capillary action
• other symptoms may include:
  • telangiectasia - small red lines showing through the skin
  • burning & stinging sensations
  • roughness or scaling

Subtype 2: Papulopustular rosacea

Characterized by:

• persistent central facial erythema
• transient papules and/or pustules
• other symptoms may include:
  • comedones
  • burning & stinging sensations
  • telangiectasia

Subtype 3: Phymatous rosacea

Characterized by:

• thickening skin
• irregular surface nodulations& enlargement
• can affect the nose, chin, forehead, cheeks or ears
• other symptoms may include:
  • patulous
  • follicles in the phymatous area
  • telangiectasia

Subtype 4: Ocular rosacea

Ocular rosacea affects the eyes. It is characterized by one or more of these features of the eye:

• watery or bloodshot appearance
• foreign body sensation - feels like sand or grit is in the eye
• burning and/or stinging
• dryness
• itching
• photosensitivity - eyes becomes sensitive to light
• blurred vision
• telangiectasia
• other symptoms may include:
  • blepharitis
  • conjunctivitis
  • irregularities of the eyelid margins