Diagnosis
- There are no specific lab tests to confirm diagnosis; hence, the diagnosis is based on clinical characteristics
Presence of ≥1 of the primary features:
- Transient erythema (flushing)
- Nontransient erythema
- Papules & pustules
- Telangiectasia
One or more of the following secondary features may also be present:
- Dry appearance
- Burning or stinging sensation
- Edema
- Plaque
- Ocular manifestations
- Phymatous features (eg rhinophyma)
- Peripheral location of lesions
Grading of Rosacea
- Rosacea clinical scorecard is used to determine the severity of rosacea
- Primary signs & symptoms may be graded as absent, mild, moderate or severe (scores of 0-3)
- Secondary features may be graded as absent or present
- Physicians give global assessment for each subtype based on severity of signs & symptoms; duration & extent of disease at the time of examination may also be considered in the evaluation
- Patient participates in the grading by giving global assessment of his/her condition considering the physical manifestations & its impact on quality of life (psychological, occupational & social effects)
Classification
- Primary & secondary features often occur together
- In most patients, a particular manifestation of rosacea is more predominant
- Patient may have characteristics of >1 subtype
Erythematotelangiectatic
- Flushing & persistent central facial erythema w/ or w/o telangiectasia
- Central facial edema, rough or scaly skin, stinging & burning sensation may be present
Papulopustular
- Persistent central facial erythema w/ transient central facial papules, pustules, or both
- Burning or stinging sensation & telangiectasias may be present
Phymatous
- Irregular surface nodularities, enlargement & thickening of the skin
- Typically occurs on the nose, chin, forehead, cheeks, or ears
Ocular
- Conjunctival hyperemia, burning or stinging sensation, foreign body sensation in the eye, dryness, pruritus, photosensitivity, blurred vision, telangiectasia of the sclera or other parts of the eye, periorbital edema
- Blepharitis, conjunctivitis, irregular eyelid margins, meibomian gland dysfunction may also occur w/ keratitis as serious complications
Variant
Granulomatous
- Noninflammatory
- Hard, brown, yellow or red cutaneous papules or nodules of similar size
- May be severe & eventually lead to scarring