Aaron F. Cohen, MD; Jeffrey D. Tiemstra, MD

Disclosures

J Am Board Fam Med. 2002;15(3) 

In This Article

Diagnosis

Rosacea develops gradually. Many patients, unaware that they suffer from a treatable skin condition, assume that the intermittent facial flushing, papules, and pustules are adult acne, sun or wind burn, or normal effects of aging. Correct diagnosis and early treatment of rosacea are important because, if left untreated, rosacea can progress to irreversible disfigurement and vision loss.[3] Rosacea is a vascular disorder of distinct, predictable symptoms that follows a remarkably homogenous clinical course. Rosacea generally involves the cheeks, nose, chin, and forehead, with a predilection for the nose in men.[4]

There are four acknowledged general stages of rosacea ( Table 1 ).[4] Stage I can be described as pre-rosacea. This stage is characterized by frequent blushing, especially in those who have a family history of rosacea. Blushing as a symptom of rosacea can start in childhood, although the typical age of onset for rosacea is 30 to 60 years.[5] There might be increased frequency of facial flushing or complaints of burning, redness, and stinging when using common skin care products or antiacne therapies. The second stage of rosacea is vascular. At this point in the disease progression, transitory erythema of midfacial areas, as well as slight telangiectasias, become apparent.[4] In the third stage of rosacea, the facial redness becomes deeper and permanent. Telangiectasias increase, and papules and pustules begin to develop. During this stage, ocular changes, such as conjunctivitis and blepharitis, can develop.[6] Edema can develop in the region above the nasolabial folds. In the fourth stage, there is continued and increased skin and ocular inflammation. Ocular inflammation can progress to keratitis and result in loss of vision. Multiple telangiectasias can be found in the paranasal region. It is at this point that fibroplasia and sebaceous hyperplasia of the skin produces the nasal enlargement known as rhinophyma.[4]

Several skin conditions share some clinical features with rosacea. Acne vulgaris causes comedones, papules, pustules, and localized inflammatory nodules but not the generalized erythema, telangiectasias, and other vascular features of rosacea. Seborrheic dermatitis, perioral dermatitis, and the malar rash of lupus can all cause mild erythema, but these conditions will not produce the characteristic flushing, telangiectasias, papules, and pustules of rosacea.[1] Sarcoidosis can closely mimic rosacea by producing red papules on the face, but the disease will usually manifest itself in other organs as well. In addition, a biopsy will show sarcoid granulomas.[7] A more complete listing of the differential diagnosis appears in Table 2 .

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