Symptoms of Rosacea and How This Skin Condition is Diagnosed

Can’t distinguish rosacea from other skin problems? Here’s a look at common symptoms of this disease, as well as information on how your doctor can make a diagnosis.

This chronic condition causes inflammation in the face, often affecting the area from the cheeks to the forehead. It’s a progressive condition, hence the importance of recognizing rosacea early and getting treatment. There’s no cure, but early intervention not only helps you manage the condition, it can reduce the severity of the symptoms. (1)

But if you’re unfamiliar with rosacea and its symptoms, you may not recognize the condition in yourself.

What Are the Symptoms of Rosacea?

Rosacea doesn’t have a single hallmark symptom but rather presents itself with multiple symptoms depending on the type of rosacea you have.

The Five Most Common Rosacea Symptoms

For the most part, however, rosacea is an inflammatory skin condition that generally presents with facial redness, warmth, and increased vessels on the skin, says Tsippora Shainhouse, MD, a board-certified dermatologist in Santa Monica, California. “It can also be associated with acne, ocular symptoms, and in men, an enlarged nose or chin,” continues Dr. Shainhouse. (1)

Symptoms range from mild to severe and vary from person to person.

Specific rosacea symptoms are based on the type.

Erythematotelangiectatic Rosacea

This type of rosacea causes redness mostly around the central part of the face. (2) Some people have visible blood vessels around their nose or cheeks, as well as swelling around the cheeks.

If you have this type of rosacea, your skin might be more sensitive to certain products such as soap, perfume, or moisturizer. Using these products can trigger increased redness or lead to dryness, roughness, and flaking. (2)

Papulopustular Rosacea

Along with facial redness, rosacea can cause acnelike pimples on the face. These bumps are sometimes tender to the touch and contain pus. (1)

Ocular Rosacea

More than 50 percent of people who have skin rosacea also develop ocular rosacea. (1) In this case, your eyelids may swell and appear red, and you’ll likely experience other eye irritations, too. This can include dry eyes or a gritty sensation in your eyes. (3) A tiny bump or sty may form on the eyelids.

When rosacea involves the eyes, some people have watery eyes, burning, or itchiness. Light sensitivity and blurry vision are other common symptoms. (4)

Ocular rosacea shouldn’t be ignored. If left untreated, it can result in eyelid and eye surface inflammation that can involve the cornea and affect vision over time, warns Erum Ilyas, MD, a board-certified dermatologist based in the Philadelphia metropolitan area.

Phymatous Rosacea

In some instances, rosacea causes the skin around the nose to thicken or enlarge, resulting in a bumpy texture. This type of rosacea is more common in men than women. (1)

Keep in mind that while rosacea commonly affects the face, it can also develop on other parts of the body, including the neck, ears, chest, back, and scalp. (2)

It’s also important to note that rosacea symptoms can be either symmetrical or asymmetrical. Some people have equal redness and symptoms on both sides of their face, while others experience milder symptoms on one side of their face and more severe symptoms on the other. (4)

Does Rosacea Cause Itching?

It depends. Some people with rosacea do report skin itching, perhaps on the cheeks. Others don’t, or they only experience itching around the eyes and eyelids. (4)

How Do Doctors Diagnose Rosacea?

Unfortunately, there isn’t one specific test to diagnose rosacea. Your doctor can only make a diagnosis after examining your skin, asking about your medical history, and running diagnostic tests to rule out other skin conditions. (5)

You can expect your doctor to examine your face for telltale rosacea symptoms during your appointment (redness, flushing, bumps, swelling, stinging, or itching). Your doctor may also check your eyes for signs of ocular rosacea. (6)

Next, you’ll have a discussion about your family history. Evidence suggests a link between rosacea and genetics. According to a survey conducted by the National Rosacea Society, about 40 percent of people diagnosed with rosacea have a relative with the condition or similar symptoms. (4)

Knowing your background helps your doctor determine whether symptoms are possibly related to rosacea or another skin disorder.

There also appears to be a link between rosacea and certain ethnicities. Rosacea can affect anyone, but it seems to be more prevalent in individuals of Scandinavian, Scottish, Welsh, and eastern European descent. (7,8)

Your doctor might be able to rule out or confirm rosacea by simply looking at the skin. But sometimes, additional testing is necessary. For example, a red rash with silvery scales often indicates psoriasis instead of rosacea. To confirm this diagnosis, your doctor may remove a skin sample (biopsy) and send this sample to a lab for evaluation. (4)

Your doctor will also need to rule out lupus, an autoimmune disease. With these types of diseases, the immune system mistakenly attacks healthy tissue and cells (such as the skin).

Blood and urine tests can distinguish lupus from rosacea, as can a skin biopsy. (4,5,6)

Blood tests will measure your number of red blood cells, white blood cells, and platelets. Low levels can be a sign of lupus. You may also need a test to evaluate your kidney and liver function, as well as the amount of protein and red blood cells in your urine. (9)

Your doctor can even order a test to check for the presence of antibodies in your bloodstream. This can point to a stimulated immune system, which is another sign of lupus. (10)

A physical examination of your skin can also differentiate rosacea from regular acne and seborrheic dermatitis.

Regular acne and rosacea typically occur separately but can develop at the same time. (4) Both conditions can involve inflamed red bumps, which may contain pus, but only acne is characterized by the presence of whiteheads and blackheads.

Your primary care physician may refer you to a dermatologist for care. And depending on the extent of your rosacea, you may need to see an ophthalmologist for eye symptoms.

Since rosacea is a long-standing condition, even if you achieve remission and notice improvement, redness and other symptoms could return. For this reason, your doctor will likely schedule periodic follow-up visits or recommend maintenance therapy to prevent recurrent flares.

Rosacea can worsen, but sticking with therapy and avoiding rosacea triggers may provide ongoing relief.

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