Medically reviewed by Dr. Nancy Shannon, MD, PhD on August 31, 2021
You may be experiencing some of the common symptoms of rosacea such as flushing or persistent facial redness, but how can you know for sure that rosacea is the root cause?
Diagnosing rosacea is more complicated than just running a test or two and analyzing the results. Medical providers need to perform examinations, go through your medical history, and work to rule out other possible conditions before an official diagnosis of rosacea can be made — and that’s not even considering the need to properly identify rosacea subtypes. Here’s what you need to know about diagnosing rosacea:
There is no medical test that determines definitively whether or not you have rosacea, so medical providers make the diagnosis based on the nature of your symptoms.
Most medical providers will begin by examining the affected areas of your skin and eyes, looking for the chronic redness or visible blood vessels that generally accompany rosacea. They’ll also ask questions such as if your face becomes flushed often or if you have a family history of rosacea — answers of “yes” to either of these questions greatly increase the chance that rosacea is causing the symptoms you experience. This assessment can also be done by visual inspection of high-quality photographs you submit via telemedicine to your provider. The Nurx app can walk you through how to take optimal photos of your face.
Because some of the common symptoms associated with rosacea can be caused by other causes, like skin irritations, allergies, or sunburn, a persistence of symptoms for several months can be a useful clue for diagnosis rosacea.Among the symptoms someone with rosacea may experience, there are 4 that dermatologists center in on:
- Regular flushing of the face, known as transient erythema
- Persistent facial redness, known as persistent erythema
- Visible blood vessels on affected parts of the skin, known as telangiectasia
- Acne-like papules and pustules on parts of the face, particularly the central face like the cheeks, nose, forehead, and chin.
Generally one more more of the four symptoms above are required for a diagnosis to be made, though other symptoms such as dryness, stinging, burning, or inflammation may support a diagnosis.
Of course, many of the symptoms of rosacea can also be the result of other conditions. Physicians at Louisiana State University have compiled a list of some of the conditions that medical providers should rule out before diagnosing someone with rosacea, including:
The pustules associated with one of the subtypes of rosacea are easily confused with the pimples caused by acne vulgaris (the medical name for classic acne). One of the key differences is that rosacea-caused pustules are not white or blackheads (comedones), unlike the blemishes caused by acne vulgaris. Moreover, rosacea can also redden and irritate the eyes (ocular rosacea).
Contact dermatitis is the medical term for irritation or a skin rash caused by friction, irritation, or an allergic reaction. While it may initially resemble rosacea, contact dermatitis subsides once the agitating material is removed.
Seborrheic dermatitis usually affects the oil-bearing areas of the skin (such as calp, eyebrows, around the nose, chest). A mild form of seborrheic dermatitis on the scalp without the redness and itching is known commonly as dandruff. Rosacea does not affect the scalp, meaning that those whose primary symptoms are not on the face are unlikely to have rosacea.
Lupus is an autoimmune disorder one of whose primary symptoms is a butterfly-shaped rash on the face. Though this rash can strongly resemble rosacea-related flushing, it will rarely develop any kind of pustules. Lupus is also characterized by other symptoms such as fatigue and joint pain, neither of which can be caused by rosacea. While patients with rosacea and lupus can be sensitive to the sun, those with lupus have more severe types of run reactions. A key differentiating feature between the rash of lupus and that of rosacea is that it spares the nasolabial folds (crease on the sides of the nose).
Identifying Rosacea Subtypes
There are 4 distinct categories which cases of rosacea can be classified as. The subtype of rosacea that you experience can determine which treatments you need.
Type 1: Erythematotelangiectatic rosacea
Type 1 rosacea, also known as erythematotelangiectatic rosacea or ET rosacea, is the “traditional” version of rosacea. ET rosacea is defined primarily by persistent flushing and redness as well as visible blood vessels. ET rosacea may be associated with skin irritation and/or burning but does not have pimples and pustules as a feature.
Type 2: Papulopustular rosacea
Papulopustular rosacea is characterised primarily by the signature acne-like pustules that accompany the background facial redness. These pustules may become more severe over time if left untreated and will only appear on parts of the face that are also afflicted by chronic redness. Of note, patients with papulopustular rosacea will not have whiteheads or blackheads (aka comedones) that are characteristic of acne vulgaris.
Type 3: Phymatous rosacea
Phymatous rosacea is a less common subtype characterized by gradual thickening of the affected skin. This skin thickening usually occurs on the nose, so persistent redness and swelling in the nasal area is a telltale sign of phymatousr osacea. Men are more commonly affected than women.
Type 4: Ocular rosacea
Ocular rosacea is rosacea that affects the eyes and can occur in conjunction with other subtypes of rosacea as well. Up to 60% of people with rosacea experience some kind of symptoms on or around the eye, making ocular rosacea one of the most common subtypes.
Luckily, there are a range of effective treatments for rosacea. Get in contact with a member of our medical team today in order to learn about what your best options are.