Rosacea is usually a clinical diagnosis; avoidance of triggers is key to management.
The most common manifestations are flushing, dilated prominent telangiectases (primarily on the face), persistent facial erythema, inflammatory papules, and pustules on the periorificial face.
Prominence of sebaceous glands on the nose may result in fibrosis and rhinophyma.
Typically, mild disease is initially treated with topical metronidazole or oral tetracyclines. Other antibiotics and anti-inflammatory agents can be used as adjuncts.
Rosacea is a common chronic disorder of the skin characterized by redness, flushing, and other cutaneous findings that often include telangiectases, roughened skin, rhinophyma, and general inflammation that can resemble acne. It primarily affects the convexities of the central face, including the cheeks, chin, nose, and central forehead, but it may extend to other parts of the body (usually the upper trunk). People with rosacea can also experience watery or irritated eyes. Rosacea is typified by episodes of remission and recurrence.
History and exam
Key diagnostic factors
- papules and pustules
- ocular manifestations
- plaque formation
- facial distribution
- phymatous changes
Other diagnostic factors
- acne vulgaris
- burning or stinging
- dry appearance
- peripheral location
- Fitzpatrick skin type I or II
- hot baths/showers
- temperature extremes
- emotional stress
- hot drinks
- family history
- female sex
- spicy foods
1st investigations to order
- clinical diagnosis
Investigations to consider
- skin biopsy
- antinuclear antibody titer
Abel D. Jarell, MD
Dermatologist and Dermatopathologist
Northeast Dermatology Associates
ADJ declares that he has no competing interests.
Dr Abel D. Jarell would like to gratefully acknowledge Dr Alexa Boer Kimball, a previous contributor to this topic.
ABK has received honoraria for consulting from Intendis and has been an investigator for Intendis and Bayer.
Jashin J. Wu, MD
Chief Dermatology Resident
University of California
JJW declares that he has no competing interests.
Paradi Mirmirani, MD
Department of Dermatology
Kaiser Permanente Vallejo Medical Center
PM declares that she has no competing interests.
Brian L. Swick, MD
Assistant Clinical Professor of Dermatology and Pathology
University of Iowa
BLS declares that he has no competing interests.
Thierry Simonart, MD, PhD
Department of Dermatology
Erasme University Hospital
TS declares that he has no competing interests.
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