Rosacea is a benign disease. However, it can negatively impact quality of life, especially if not managed early. If there is any doubt about the onset of symptoms, it is advisable to consult a healthcare professional for a diagnosis. Here is how the process unfolds.
How is the diagnosis of rosacea made?
Published on March 6, 2024, by Kahina, Scientific Editor — 5 min of reading
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How is rosacea diagnosed?
The diagnostic practice of rosacea most commonly used follows the 2002 recommendations of the National Rosacea Society (NRS). The diagnosis of rosacea is exclusively clinical. The dermatologist's visual examination and their questioning are the two main pillars of the diagnosis. It initially takes place based on an anamnesis, which is a collection of information provided to the doctor by the patient/their surroundings about the history of a disease or the circumstances that preceded it, followed by a physical examination based on "indicative" criteria of the presence of rosacea.
| Presence of one or more of the following primary characteristics | May include one or more of the following secondary characteristics |
|---|---|
| Vasomotor Flushes | Burn or stinging sensation |
| Non-transient erythema | Patches |
| Papules/Pustules | Dry Appearance |
| Telangiectasias | Oedema |
| Ocular Manifestations | |
| Peripheral location | |
| Phymatous Changes |
The primary and secondary characteristics of rosacea described above are often associated. The most common groups of signs are referred to as subtypes specific to rosacea. Each subtype includes the fewest signs necessary to make a subtype diagnosis.
| Subtypes (+ one variant) | Associated Characteristics |
|---|---|
| Erythematotelangiectatic Rosacea | Hot flushes and persistent central facial erythema with or without telangiectasia. |
| Papulopustular Rosacea | Persistent central facial erythema with transient central facial papules and/or pustules. |
| Phymatous Rosacea | Thickening of the skin, irregular superficial nodules and enlargement; can appear on the nose, chin, forehead, cheeks or ears. |
| Ocular Rosacea | Feeling of a foreign body in the eye, burning or tingling sensation, dryness, itching, ocular photosensitivity, blurred vision, telangiectasia of the sclera or other parts of the eye, or periorbital oedema. |
| Granulomatous Rosacea (variant) | Non-inflammatory skin papules, hard, brown, yellow or red, or nodules of uniform size. |
Patients can receive an incorrect diagnosis for skin conditions that present similar characteristics. Rosacea is often misdiagnosed as a common acne, a photodermatitis, a seborrheic dermatitis, or a contact dermatitis. A differential diagnosis could take place and a skin biopsycan be performed to definitively rule out other diagnoses.
However, these recommendations are currently the subject of controversy. Martin SCHALLER and his colleagues have found that patients can simultaneously exhibit characteristics of several subtypes of rosacea, and that these characteristics can evolve between subtypes, making this method somewhat confusing. They propose a new foundation for diagnosis based on the "phenotype" rather than the subtypes.
According to them, a phenotype-based approach could enhance outcomes by addressing the clinical presentation and taking into account the individual patient's experience. A consensus has emerged on the need to havecategorical scales effective for assessing the skin characteristics of rosacea. Furthermore, the severity of these characteristics should be evaluated on a five-point categorical scale including "mild/absent" and "almost mild/minimal", in addition to "mild", "moderate" and "severe".
Following the clinical examination, the clinical situation can be stated and the treatments potential can be prescribed.
Sources
POWELL F. & al. Standard classification of rosacea: Report of the National Rosacea Society Expert Committee on the classification and staging of rosacea. Journal of the American Academy of Dermatology (2002).
PHILLIPS-SAVOY A. R. & al. Rosacea: Diagnosis and treatment. American Academy of Family Physicians (2015).
SCHALLER M. & al. Updating the diagnosis, classification and assessment of rosacea: recommendations from the global ROSacea COnsensus (ROSCO) panel. British Journal of Dermatology (2016).
