Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Differentiating between acne rosacea and other similar skin conditions, such as acne vulgaris, during a consultation involves observing key clinical features and considering the patient's history NICE CKS,NICE NG198.
- Presence of Comedones: A primary distinguishing factor is the presence of comedones (blackheads and whiteheads) in acne vulgaris, which are typically absent in rosacea Libon et al. 2015 NICE NG198.
- Lesion Characteristics:
- Rosacea commonly presents with persistent facial erythema (redness), flushing, and visible blood vessels (telangiectasia) NICE CKS. It may also include papules and pustules, but unlike acne, these are not associated with comedones NICE CKS. Rosacea can also lead to skin thickening (phymatous changes, such as rhinophyma) and may involve the eyes, causing symptoms like dry eye, blepharitis, or more serious complications such as keratitis or anterior uveitis NICE CKS.
- Acne vulgaris is characterized by comedones, papules, pustules, nodules, and cysts, which can lead to scarring and persistent pigmentary changes NICE NG198.
- Affected Areas: Rosacea primarily affects the central face, including the cheeks, nose, forehead, and chin NICE CKS. Acne vulgaris can affect the face, back, and chest NICE NG198.
- Triggers: Rosacea is often exacerbated by specific triggers such as sun exposure, heat, spicy foods, alcohol, and stress, which patients may identify by keeping a diary NICE CKS. While diet can be a factor in acne vulgaris, specific triggers are less emphasized in the provided context NICE NG198.
- Diagnostic Uncertainty and Skin of Colour: If there is diagnostic uncertainty for either condition, particularly in people with darker skin phototypes where features like erythema and telangiectasia may be difficult to detect in rosacea, referral to a dermatologist should be considered NICE CKS Tan 2017Gallo 2018Alexis 2019Maruthappu & Taylor 2022. A dermatoscope may be helpful in detecting telangiectasia in darker skin types for rosacea NICE CKS Gallo 2018Alexis 2019. For acne, persistent pigmentary changes are a reason for referral NICE NG198.