The Diagnosis of Rosacea

Rosacea typically affects the convexities of the central face. The presence of one or more of the following signs with a central face distribution is indicative of rosacea. These signs are commonly transient, and each may occur independently. Many patients may present with more than one of these diagnostic features.
Flushing (transient erythema).
A history of frequent blushing or flushing is common.
Nontransient erythema.
Persistent redness of the facial skin is the most common sign of rosacea.
Papules and pustules.
Dome-shaped red papules with or without accompanying pustules, often in crops, are typical. Nodules may also occur. Although patients with concomitant acne may exhibit comedones, comedones should be considered part of an acne process unrelated to rosacea.
Telangiectasia.
Telangiectases are common but not necessary for a rosacea diagnosis.

The following signs and symptoms often appear with one or more of the primary features of rosacea, but in some patients can occur independently.
Burning or stinging.
Burning or stinging sensations with or without scaling or dermatitis may occur, especially on malar skin.
Plaque.
Elevated red plaques without epidermal changes in the surrounding skin may occur.
Dry appearance.
Central facial skin may be rough and scaling so as to resemble dry skin and suggest an eczematous dermatitis, and may often include the coexistence of seborrheic dermatitis. This “dryness” may be associated with burning or stinging sensations, and may be caused by irritation rather than the disease process.
Edema.
Edema may accompany or follow prolonged facial erythema or flushing. Sometimes soft edema may last for days or be aggravated by inflammatory changes. Solid facial edema (persisting hard, nonpitting edema) can occur with rosacea, usually as a sequel of the papulopustular type, and also independently of redness, papules and pustules, or phymatous changes.
Ocular manifestations.
Ocular manifestations are common, and range from symptoms of burning or itching to signs of conjunctival hyperemia and lid inflammation. Styes, chalazia, and corneal damage may occur in many patients with rosacea in addition to cutaneous stigmata. The severity of ocular manifestations may not be proportional to those of the skin.
Peripheral location.
Rosacea has been reported to occur in other locations, but the frequency and occurrence of this are ill-defined. Rosacea in peripheral locations may or may not be accompanied by facial manifestations.
Phymatous changes.
These can include patulous follicles, skin thickening or fibrosis, and a bulbous appearance. Rhinophyma is the most common form, but other phymas may occur.