What does rosacea look like?

Characteristics of Rosacea

Rosacea is characterized by persistent centrofacial erythema, telangiectasia, inflammatory papules/pustules, and phymatous changes, primarily affecting the central face. 1

Diagnostic Features

Major Features (Essential for Diagnosis)

• Persistent centrofacial erythema associated with periodic intensification by potential trigger factors 1
• Phymatous changes (cutaneous thickening, deformation, inflammation) are independently diagnostic 1

Major Features (Not Individually Diagnostic)

• Flushing/transient erythema - characterized by intensity, frequency, duration, and area of involvement 1
• Telangiectasia - visible dilated blood vessels 1
• Inflammatory papules and pustules 1
• Ocular manifestations - ranging from mild blepharitis to severe sclerokeratitis 1

Minor Features

• Burning sensation 1
• Stinging sensation 1
• Edema 1
• Dry sensation 1

Clinical Presentation

Cutaneous Manifestations

• Centrofacial location is essential for diagnosis (affecting cheeks, nose, chin, and forehead) 1, 2
• Bilateral facial involvement is typical but not essential 1
• Inflammatory lesions may vary in number and extent of facial involvement 1
• Persistent erythema varies in intensity and extent 1

Phymatous Changes

• Most commonly affects the nose (rhinophyma) 1, 3
• Characterized by inflammation, cutaneous thickening, and deformation 1
• Photographs are essential to assess severity of phymatous changes 1

Ocular Manifestations

• Can range from mild to severe 1
• May present with or without skin disease 1
• Includes blepharitis with lid margin telangiectasia (mild), blepharoconjunctivitis (mild-to-moderate), blepharokeratoconjunctivitis (moderate-to-severe), and sclerokeratitis/anterior uveitis (severe) 1

Special Considerations

Rosacea in Darker Skin Types

• Diagnosis can be challenging in skin phototypes V and VI 1
• Erythema and telangiectasia may not be visible 1
• Greater emphasis should be placed on hyperpigmentation and symptoms of irritation (burning and stinging) 1
• Skin biopsy may be considered for diagnostic support 1

Rosacea in Children

• Ocular symptoms can appear before cutaneous symptoms, leading to misdiagnosis 1
• May present with chronic recurrent blepharokeratoconjunctivitis, punctate erosions, peripheral keratitis, meibomian gland disease, or recurrent chalazia 1
• Children with a history of styes have an increased risk of developing adult rosacea 1

Impact on Quality of Life

• Rosacea significantly affects emotional health and quality of life 4
• The condition can have detrimental effects on psychological and social interactions 3
• Assessment should include patient-reported features (both visible and non-visible) 1
• Treatment goals should include reduction in the impact of rosacea on the patient 1

Epidemiology

• Affects up to 10% of the world population 5
• More common in fair-skinned individuals (skin types I and II) 3, 5
• Typically affects individuals aged 35-50 5
• Women are affected more often than men, though it can be more severe in men 1, 5