Rosacea Differential Diagnosis

When considering a differential diagnosis for rosacea, it's essential to evaluate various conditions that may present with similar symptoms. The following categories help organize the potential diagnoses:

• Single Most Likely Diagnosis
  • Acne: Often confused with rosacea due to the presence of papules and pustules, acne is a common condition that can be distinguished from rosacea by the presence of comedones (blackheads and whiteheads) and a more widespread distribution of lesions.
• Other Likely Diagnoses
  • Seborrheic Dermatitis: Characterized by a red, itchy rash on the face, seborrheic dermatitis can resemble rosacea but tends to have a more greasy, scaly appearance and often involves the eyebrows and nasolabial folds.
  • Perioral Dermatitis: Presents with small papules and pustules around the mouth, perioral dermatitis can be mistaken for rosacea but is typically confined to the perioral area and may be triggered by the use of topical corticosteroids.
  • Keratosis Pilaris: A condition causing small, rough bumps on the skin, keratosis pilaris can sometimes be confused with the papules of rosacea, especially when it affects the face, but it tends to have a more sandpapery texture.
• Do Not Miss Diagnoses
  • Lupus: Systemic lupus erythematosus can cause a butterfly-shaped rash across the cheeks and nose, which might be mistaken for rosacea. Missing this diagnosis could lead to delayed treatment of a potentially serious autoimmune disease.
  • Sarcoidosis: This condition can cause skin lesions that resemble rosacea, but it's a systemic disease that can affect multiple organs, including the lungs and eyes. Early diagnosis is crucial for effective management.
• Rare Diagnoses
  • Demodex Folliculitis: Caused by an overabundance of Demodex mites in the hair follicles, this condition can mimic rosacea with its papules and pustules but is less common and might require specific treatments targeting the mites.
  • Granulomatous Rosacea (Lupus Perio): A rare variant of rosacea characterized by granulomatous inflammation, it can be distinguished by its distinctive histopathological features and may require different treatment approaches.

Each of these diagnoses has distinct features that can help differentiate them from rosacea, emphasizing the importance of a thorough clinical evaluation and, when necessary, additional diagnostic tests to ensure an accurate diagnosis and appropriate treatment plan.