Diagnosis: Rosacea
Our patient had rosacea, an inflammatory condition of the skin that typically affects the convex portions of the central face. This chronic cutaneous disorder usually starts after age 30 in both men and women, and is more prevalent in those with fairer skin.1 In fact, an epidemiologic study showed the prevalence to be as high as 10% in the Swedish population.2 The condition, which is not life threatening, can be controlled, although not cured. Its effect on appearance may have a negative impact on a patient’s quality of life.
The etiology and pathogenesis of rosacea are unknown. However, different pathogenic mechanisms have been discussed in the literature, including vasculature reactivity, dermal matrix degeneration, microbial organisms, and activities that cause flushing or blushing, such as spicy food, alcohol consumption, or emotional stressors. Rosacea flare-ups have also been linked to extremes in temperature, as was the case with our patient.
Due to the varied clinical manifestations, it is likely that genetics may also play a role in the development of rosacea.3,4
The differential. Rosacea can be confused with acne, systemic lupus erythematosus, and sarcoidosis.
A standardized approach to diagnosing rosacea
In 2002, an expert committee assembled by the National Rosacea Society established primary and secondary criteria for diagnosing rosacea.5 Diagnosis is based on the presence of 1 or more of the following signs in a central face distribution:
- flushing (transient erythema)
- persistent erythema
- papules and pustules
- telangiectasia.
Additionally, 1 or more of the following secondary features may also be present:
- burning or stinging
- elevated red inflammatory papules or plaques
- dry appearance
- edema
- ocular manifestations
- extrafacial rosacea
- phymatous changes (most commonly on the nose).
Rosacea comes in many forms
According to the expert committee assembled by the National Rosacea Society, the primary and secondary features (above) can be used to designate specific subtypes of rosacea.
Erythematotelangiectatic rosacea is generally characterized by flushing and persistent central facial erythema. However, a history of flushing alone is common among these patients.5 Flushing episodes usually last longer than 10 minutes3 and can be triggered by any vasodilating stimulus, like exercise, cold, heat, sunlight, hot beverages, or alcohol.6-8