Rosacea: An Introduction

Diagnosis

In the past many specialists have failed to correctly identify rosacea, probably because the rosacea lesions can so closely resemble acne.

However, even though a Rosacea papule or pustule may imitate acne, the key differentiation is that in Rosacea, there is no microcomedone activity present and Propionibacterium is not a factor.

Most commonly, the clinical onset of Rosacea begins between ages 30 to 50 years, but can occur in adolescence or in the elderly.

The diagnosis of acne rosacea is based exclusively on clinical findings, primarily typical skin changes.

There are no available diagnostic tests.

However, when ocular symptoms precede the skin changes as seen in 20% of cases, diagnosis may be difficult.

The ocular changes when seen in combination with erythema and telangiectasias of the central area of the face accompanied by papules pose no diagnostic difficulty.

A group of patients with ocular rosacea may have minimal objective signs despite marked symptoms requiring the ophthalmologist to rely heavily on the dermatologic findings to confirm the diagnosis.

Differential Diagnosis of Rosacea

The differential diagnosis of acne rosacea includes acne vulgaris, seborrheic dermatitis, lupus erythematosus, syphilis, tuberculosis, periorbital dermatitis, lupus malaris disseminatus, erysipelas, polymorphous light eruption, actinic reticuloid, and chronic topical corticosteroid therapy.

A carcinoid syndrome with episodic facial flushing may resemble acne rosacea and as mentioned previously may eventually result in acne rosacea.

However, the 24-hour urinary excretion of five hydroxy indoleacetic acid is normal in acne rosacea.

The differential diagnosis of ocular rosacea includes staphylococcal and seborrheic blepharokeratoconjunctivitis and sebaceous gland carcinoma.


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