Rosacea is a common skin condition, but it can be challenging to identify on your own. Typical rosacea symptoms, like facial flushing and pustules, are easy to confuse with other skin issues, like
acne.
It’s also common for
rosacea to occur alongside other skin problems. Indeed, one survey found that 77 percent of rosacea patients also had at least one other skin condition.
This can make it even harder to reach an accurate diagnosis.
The best way to find out if you have rosacea or something else is to consult a dermatologist. But you can get a better idea of what you may be experiencing if you understand the other common culprits.
Rosacea, sometimes called acne rosacea, is a chronic inflammatory skin disease. Rosacea can be mild to severe, and over time, the redness (or flushing) can spread from your cheeks and nose to your chin and forehead.
Depending on the type of rosacea you have, symptoms can also include:
- Thickening of the skin around the nose
- Bumps or pimples
- Blushing or flushing (can be temporary or persistent)
- Skin sensitivity
- Enlarged blood vessels
“A distinctive form is rhinophyma, when the nose enlarges and develops large nodules; similar changes can sometimes occur on other facial areas, such as the chin,” says Viktoryia Kazlouskaya, MD, PhD, a dermatologist at Dermatology Circle in New York City.
Rosacea commonly affects the face, namely the nose, cheeks, and chin, but can also appear on the:
- Chest
- Ears
- Forehead
- Neck
- Scalp
- Eyes
Rosacea is most common in people with fair skin.
It also occurs in other skin types, but it’s less noticeable in people with darker skin. So much so that rosacea can be underdiagnosed or flat-out missed in every other ethnicity, says
Erum Ilyas, MD, a board-certified dermatologist at Schweiger Dermatology Group in King of Prussia, Pennsylvania.
“I routinely have patients of color who have seen numerous other doctors, but have had their diagnosis missed simply because their skin type didn’t show the classic ‘rosy cheeks,’” says Dr. Ilyas.
Skin thickening, swelling, and
acne-like breakouts that don’t improve with acne medication are common symptoms with all skin tones. But with darker skin tones, rosacea doesn’t always appear as redness. Instead, it can appear like:
- Dry, swollen skin
- Patches of darker skin or discoloration
- Hard yellow or brown bumps around your mouth or eyes
- Skin sensitivity
Several other conditions can produce the skin redness and acne-like bumps of rosacea. Here’s how to spot them.
Acne
Acne develops when small pores in your skin become clogged with oil and dead skin cells and may become inflamed. Symptoms can vary from person to person, but may include red lumps or spots, tiny white bumps, and dark spots with open pores.
These types of bumps (which may or may not have pus) can also be a sign of rosacea.
But one sign that distinguishes acne from rosacea is the distribution.
Rosacea tends to be concentrated in the central face area, while acne can be widely distributed across the face.
Cutaneous Lupus
Lupus is another skin condition that can be mistaken for rosacea. This chronic autoimmune disease causes
inflammation in different parts of the body, including the skin.
Inflammation results when the immune system attacks healthy cells and tissues. For lighter-skinned people, one distinct
symptom of lupus is a red facial rash. This rash can cover both cheeks and usually has a butterfly shape.
Along with the potential of rosy cheeks, the rash can cover the bridge of the nose. But while a rosacea rash may look like lupus, the difference is a
lupus rash doesn’t have red bumps that are typical of rosacea, although the rash can be raised.
Other symptoms that may accompany a lupus rash include fever, fatigue, joint pain and stiffness, headache, dry eyes, and shortness of breath. If you’re experiencing any of these alongside a developing facial rash, consult your doctor. A blood test can help rule out this condition.
Eczema
Because eczema can lead to reddened skin, it can sometimes be confused with rosacea. A major difference is the itching and scaly feel that eczema causes.
Often beginning in early life, eczema refers to a number of skin conditions that cause inflammation, including
atopic dermatitis, stasis dermatitis and
contact dermatitis. Some typical symptoms include:
- Rash
- Itchiness
- Dryness
- Blisters
“Usually associated with a scaly rash and intense itching. Many patients have a history of eczema since childhood and often experience it on other body sites. Sensitive skin is also common,” says Dr. Kazlouskaya.
While some people’s symptoms may lessen over time, eczema is a chronic condition with no known cure.
Seborrheic Dermatitis
This skin condition is often found on the scalp, causing red patches and scaly dandruff. It can also develop on other parts of the body, including the face and the nose, so it’s sometimes mistaken for rosacea.
It’s possible to have
seborrheic dermatitis and rosacea at the same time, but there is a way to tell these conditions apart. In addition to redness, seborrheic dermatitis tends cause flaking in the:
- Eyebrows
- Forehead
- Creases around the nose
- External ear canal
And, if you have seborrheic dermatitis alone, you won’t have red, swollen bumps or pus-filled pimples that are typical with rosacea.
Psoriasis
Another skin condition that can lead to skin sensitivity and redness is psoriasis. The most common type of psoriasis is called plaque psoriasis.
Plaque — or thick, scaly patches of skin — can appear anywhere, but most often show up on the:
- Elbows
- Knees
- Lower back
- Scalp
In addition to severe itching, those with psoriasis often have skin that burns, or feels painful and tight.
“Psoriasis can affect the face but more typically appears on the scalp, trunk, and extremities, especially the knees and elbows. It is characterized by well-demarcated areas covered with silvery scales,” says Kazlouskaya.
Perioral Dermatitis
This may resemble rosacea, and some believe it’s related. But perioral dermatitis mainly affects the area around the mouth, while rosacea more often affects the cheeks, says Kazlouskaya. It’s strongly associated with topical steroid use.
Perioral dermatitis symptoms include:
- Red or inflamed rash
- Skin scaling
- Pustules
- Sensitivity to skin care
While
perioral dermatitis can return after treatment, and repeat cases can turn into rosacea, they are two different conditions.
Demodex Folliculitis
“Demodex is a normal skin mite that sometimes increases in density and triggers inflammation,” says Kazlouskaya. “Demodex folliculitis presents as itchy inflammatory bumps and pustules.”
According to Kazlouskaya, on average, these patients have more demodex mites per pore. These mites can be identified under the microscope if pustular contents are examined.
Demodex folliculitis may contribute to the red bumps of rosacea.
While these are two separate conditions, microscopic organisms that normally inhabit hair follicles in low numbers appear to be more numerous in those with rosacea, says Anna Guanche, MD, a board-certified dermatologist based in Calabasas, California.
If you think you have rosacea, don’t ignore the symptoms. While rosacea can’t be cured, treatment can help you manage symptoms and reduce flares. More importantly, symptoms can become increasingly worse without intervention.
Becoming aware of — and avoiding — any strong triggers can also keep breakouts and redness under control. This means seeing a dermatologist is a good first step to get the right diagnosis and appropriate care.
“It is always a good idea to see a board-certified dermatologist for advice and treatment options. A consultation is especially important when symptoms are not manageable with simple avoidance measures and gentle skin care,” says Kazlouskaya.
There isn’t a specific laboratory test to diagnose rosacea. Your doctor will examine your skin and eyes, ask about your medical history, and you’ll likely undergo tests to rule out
skin conditions with similar symptoms.
“Usually, a clinical examination is sufficient to diagnose rosacea, as its features are quite distinct,” says Kazlouskaya. “Dermatologists are trained to recognize it during their specialized training, and additional testing is rarely necessary unless the presentation resembles another condition or the treatment trial is ineffective.”
