What are the signs and symptoms of rosacea?

Signs and Symptoms of Rosacea

Rosacea is primarily characterized by persistent centrofacial erythema (facial redness) with periodic intensification by trigger factors and/or phymatous changes, which are individually diagnostic features of the condition. 1

Diagnostic Features

Primary Diagnostic Features:

• Persistent centrofacial erythema with periodic intensification by trigger factors 1
• Phymatous changes (thickening of skin, cutaneous deformation) 1

Major Features

Cutaneous Signs:

• Flushing/transient erythema - characterized by intensity, frequency, duration, and area of involvement 1
• Persistent erythema - varies in intensity and extent 1
• Inflammatory papules and pustules - number and distribution across face 1
• Telangiectasia - visible blood vessels of varying size and extent 1
• Phymatous changes - involving inflammation, cutaneous thickening, deformation (commonly affecting nose as rhinophyma) 1, 2

Ocular Manifestations:

• Mild: Blepharitis with lid margin telangiectasia 1
• Mild-to-moderate: Blepharoconjunctivitis 1
• Moderate-to-severe: Blepharokeratoconjunctivitis 1
• Severe: Sclerokeratitis, anterior uveitis 1
• Other ocular findings: Recurrent chalazia, punctate erosions, peripheral keratitis, meibomian gland disease 1

Minor Features

Sensory Symptoms:

• Burning sensation 1
• Stinging sensation 1
• Dry sensation 1
• Facial edema 1

Clinical Presentation Variations

By Skin Type:

• More easily visible in fair-skinned individuals 1
• May be challenging to diagnose in darker skin tones due to difficulty visualizing telangiectasia or facial flushing 1
• In darker skin types, diagnosis may rely more on symptoms of irritation and hyperpigmentation 1

By Age:

• Typically affects adults aged 35-50 2
• In children, ocular symptoms may appear before cutaneous manifestations 1
• Children with ocular rosacea often present with corneal involvement and asymmetry of ocular disease 1

By Gender:

• More prevalent in women 2, 3
• Can be more severe when occurring in men 1

Important Clinical Considerations

Diagnostic Pitfalls:

• Rosacea is often misdiagnosed as acne, but lacks comedones 4, 3
• Unlike acne, rosacea typically doesn't involve extra-facial areas 3
• In children, diagnosis is frequently overlooked due to subtle cutaneous signs 1
• Ocular rosacea may occur without significant skin involvement 3

Impact on Quality of Life:

• Rosacea can significantly impact psychosocial well-being and quality of life 5, 3
• The condition's effect on emotional health is often underestimated 3

Disease Course:

• Chronic condition with periods of exacerbation and remission 1
• Can be effectively controlled with appropriate treatment and trigger avoidance 6
• Severe cases may lead to permanent skin changes if left untreated 1

Understanding these signs and symptoms is crucial for early diagnosis and management, particularly recognizing that persistent centrofacial erythema with periodic intensification by triggers is the minimum diagnostic feature of rosacea 1.