How is rosacea diagnosed?

You might find yourself getting flushed, face turning red, burning when you skincare product. You might first brush it off as acne, skin problems, or just natural redness. If you look like your blushing with small skin bumps that look like acne, you likely have a condition called rosacea. Rosacea is a long-term common condition in middle-aged women who have fair skin; however, the symptoms are worse in men. The symptoms present with redness of the face and visible blood vessels in the face. It might also present with small, red, pus-filled bumps. These symptoms might come in cycles, where it flares up then disappears for a while. There is currently no cure for rosacea but there are treatments out there to managed and control the symptoms. Your doctor can prescribe you medication or treatments to help manage them or there are steps you can at home to make yourself feel better.

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Symptoms

• Facial redness: There is usually persistent redness around the center part of the face. Small blood vessels can be seen around the nose and cheeks become visible. 
• Swollen red bumps: People suffering from rosacea may also notice acne-like pimples on their face which may or may not contain pus. The skin might feel hot and tender. 
• Eye problems: Many suffering from rosacea may also notice their eyes become dry and irritated. They may also swell and become red. This is known as ocular rosacea. In some, the eye symptoms might present before facial symptoms. 
• Enlarged nose: As time goes on, the skin around your nose can thicken making it look bulbous in appearance. This usually occurs more in med than women. 

Triggers

There have been no findings behind the causes of rosacea, but there are known triggers that make the symptoms worse. The triggers are:

• Alcohol
• Spicy foods
• Cheese
• Caffeine
• Hot drinks
• Aerobic exercise 

By avoiding these known triggers, you can prevent the symptoms of rosacea from presenting. 

Diagnosis

There is no specific diagnostic tool that is used to diagnose rosacea. Your doctor relies on the history you give them and the symptoms you present with. They might also do an examination of your skin. They might carry out tests to rule out other conditions that present with the same symptoms such as psoriasis, eczema, or lupus. 

Differential diagnosis that can present similarly to rosacea:

Acne Vulgaris 

Acne vulgaris is an inflammatory condition that occurs due to a blocked hair follicle in the skin. This blockage usually involves oil or skin cells. You may notice these other symptoms:

• Whiteheads
• Blackheads
• Tender red bumps called papules
• Pustules, containing pus
• Painful lumps below the skin called modules and cystic lesions

Seborrheic dermatitis 

Seborrheic dermatitis is a form of chronic eczema. It appears where there are a large number of sebaceous glands (oil-producing glands) like the upper back, nose, and scalp. It can present with these symptoms:

• Redness
• Greasy, swollen skin
• White or yellowish crusty flakes
• Itchy and burning sensation 
• Pink-colored patches most commonly seen on people in dark skin

Perioral dermatitis 

Perioral dermatitis is an inflammatory condition resulting in a rash around the mouth. It is more common in women between the ages of 16 to 45. It presents with:

• Red bump rash around the mouth and in the nose folds
• Scaly bumps
• Bumps may contain pus or fluid 
• Burning or itching if the rash worsens

These may resemble acne in appearance.

Carcinoid syndrome 

Carcinoid syndrome occurs then a rare cancerous tumor (carcinoid tumor) releases chemicals into the bloodstream. This results in a variety of symptoms usually in people with advanced carcinoid tumors. The symptoms are:

• Skin flushing 
• Skin facial lesions 
• Diarrhea
• Difficulty breathing 
• Heart palpitations

Lupus erythematosus

Systemic lupus erythematosus (SLE) is a chronic inflammatory condition causing inflammation to joints, skin and other organs. This condition occurs when the body attacks its own organs and tissues. SLE does not present identically in different people. They may present suddenly or gradually over a period of time. Common symptoms of SLE are:

• Fatigue 
• Fever
• Joint pain, stiffness or swelling
• Butterfly shaped rash on the face covering the cheeks can nose 
• Body rashes
• Skin lesions appearing or worsening when exposed to sunlight 
• Shortness of breath
• Chest pain 
• Dry eyes
• Headaches 
• Confusion 
• Memory 
• Fingers and toes that turn white or blue during times of cold or stressful periods

Rosacea can cause embarrassment or anxiety. You might become more self-conscious about your appearance and upset about the way others react to your face. Talking to a counselor can help you tackle these feelings. There are also rosacea support groups that will put you in contact with others facing the same problem. Remember you are not alone, there are others out there affected by the same condition. 
 

References

1. nhs.uk. (2017). Rosacea. [online] Available at: https://www.nhs.uk/conditions/rosacea/ [Accessed 5 May 2020].
2. Healthline. (n.d.). Acne Vulgaris: Symptoms, Pictures, Treatments, and More. [online] Available at: https://www.healthline.com/health/skin-disorders/acne-vulgaris [Accessed 7 May 2020].
3. ‌National Eczema Association. (2013). Seborrheic Dermatitis | National Eczema Association. [online] Available at: https://nationaleczema.org/eczema/types-of-eczema/seborrheic-dermatitis/.
4. Healthline. (n.d.). Perioral Dermatitis: Symptoms, Causes, and Treatment. [online] Available at: https://www.healthline.com/health/perioral-dermatitis#symptoms [Accessed 7 May 2020b].
5. ‌Mayo Clinic. (2018). Carcinoid syndrome - Symptoms and causes. [online] Available at: https://www.mayoclinic.org/diseases-conditions/carcinoid-syndrome/symptoms-causes/syc-20370666.
6. ‌Mayo Clinic. (2017). Lupus - Symptoms and causes. [online] Available at: https://www.mayoclinic.org/diseases-conditions/lupus/symptoms-causes/syc-20365789.

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