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Tests to Differentiate Rosacea


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In the past a diagnosis of rosacea usually required only a physical examination and a patient history by a qualified medical physician. Currently there are now a number of tests that may be considered to differentiate rosacea from a plethora of other skin conditions and diseases that present with erythema.

The following list are some tests or tools you may consider for your investigation which you may want to ask your physician about that we have listed in alphabetical order. 

Bacterial Culture "bacterial cultures and antibiograms" [1]

Baumann Skin Type Indicator (BSTI)

ANA Blood Test to rule out Grave’s disease, Lupus and Scleroderma

Autologous serum skin test (ASST) to rule out chronic uticaria

Blood tests for PCT, MPV, and RDW [21]

Computer Aided Diagnosis [2]

C-reactive protein (CRP) [13] [15]

Demodex Density Quantification (Several methods to quantify demodex) [3]

Erythema‐directed digital photography (EDDP) [16]

Fecal calprotectin (FC) Test for Rosacea [4]

Fungal KOH and fungal culture [5]

GPSkin® Barrier Device for Rosacea

Mast Cell Density Count [14]

Monocyte Subset (Increase in Abnormal Frequency Level) [19]

Nailfold Capillaroscopy (NFC) [17]

Oxidative status [17]

Polarized Light Dermoscopy to test for Rosetts

ROAT or Patch Test to rule out sensitive skin or allergic reaction [6]

Serum ADA level [12]

Serum Cathelicidin Level [11]

Serum Endocan Level

Serum IL-17 Level [10]

Serum levels of CCL3, CXCL8, CXCL9, and CXCL10 

"Serum peroxide and cutaneous ferritin levels are increased, whereas serum total antioxidative potential levels are decreased, in patients with rosacea." [20]

Serum Uric Acid (UA) level [15]

Serum Zonulin Level [7]

Skin Hydration Test [18]

Skin Measurement [8]

Thiol-disulfide homeostasis (TDH) and metabolic parameters

Thyroid Tests [9]


Diagnosing Rosacea

Diagnosing Rosacea in Five Minutes or Less

End Notes 

[1] Przegl Lek. 2007;64(12):991-6.
[The assessment of bacterial flora and antibiotic-sensitivity of bacteria isolated from conjunctival sac, skin of the eyelids and inflammatory lesions in patients with acne vulgaris and rosacea]
Katarzyna Kaszuba-Bartkowiak, Roman Goś

[2] Computer Aided Diagnosis in Rosacea Erythema

[3] Methods for Quantifying Demodex Mites

[4] Fecal calprotectin (FC) Test for Rosacea

[5] Rosacea Diagnosis and Management by Frank Powell
with a Contribution by Jonathan Wilkin

[6] ROAT or PATCH Test

[7] J Dermatolog Treat. 2020 Apr 15;:1-13
Measurement of the serum zonulin levels in patients with acne rosacea.
Yüksel M, Ülfer G

[8] Br J Dermatol. 2019 May 23;:
Non-invasive objective skin measurement methods for rosacea assessment: a systematic review.
Logger JGM, de Vries FMC, van Erp PEJ, de Jong EMGJ, Peppelman M, Driessen RJB

[9] "Our findings indicate that thyroid blood tests, including thyroid autoantibodies, should be tested and thyroid ultrasounds should be performed in patients diagnosed with rosacea." 

Dermatol Ther. 2020 Dec 05;:
investigation of thyroid blood tests and thyroid ultrasound findings of patients with rosacea.
Gönülal M, Teker K, Öztürk A, Yaşar FY

[10] Serum IL-17 levels in Patients with Rosacea

[11] Several clinical papers indicate that serum cathelicidin levels in rosacea patients are high
For more information

[12] Role of Adenosine Deaminase in Patients with Erythematotelangiectatic Rosacea and Demodex folliculorum Positivity

[13] One study in Finland looked at levels of C-reactive protein (CRP), commonly used in clinical studies as a strong marker for inflammation. The researchers found that individuals with slightly elevated blood levels of CRP were 1.7 times more likely to have rosacea than normal individuals. The study concluded, "low grade inflammation is present in several skin diseases," including rosacea.

Acta Derm Venereol. 2017 Sep 13. doi: 10.2340/00015555-2795. 
The Association Between Low Grade Systemic Inflammation and Skin Diseases: A Cross-sectional Survey in the Northern Finland Birth Cohort 1966.
Sinikumpu SP, Huilaja L, Auvinen J, Jokelainen J, Puukka K, Ruokonen A, Timonen M, Tasanen K.

[14] "One study showed that the number of mast cells was significantly higher in lesions than in clinically uninvolved skin in patients with papulopustular and erythematotelangiectatic rosacea, and there was a positive correlation between mast cell density and the duration of rosacea."

Dermatology Times, Dermatology Times, May 2020 (Vol. 41, No. 5), Volume 41, Issue 5
Mast cells may play key role in rosacea pathogenesis
Ilya Petrou. M.D.

Arch Dermatol Res. (2008) 300:125–31.
A study of the pathogenesis of rosacea: how angiogenesis and mast cells may participate in a complex multifactorial process. 
Aroni K, Tsagroni E, Kavantzas N, Patsouris E, Ioannidis E. 

[15] Evaluation of serum uric acid levels in patients with rosacea.

[16] "Instrumental evaluation of erythema degree was performed by erythema‐directed digital photography (EDDP)" which is "able to provide a more defined evaluation of erythema changes."  "Erythema‐directed digital photography is non‐invasive technique that is able to provide more precise evaluation of patient's erythema grade compared to simple clinical inspection or standard clinical photography. In particular, advanced digital photography equipped with RBX™ processing system is able to highlight the red areas corresponding to skin vascularization representing a useful tool for a more accurate evaluation of erythema/inflammation grading in some inflammatory facial disorders including rosacea. This technique may also be used to enhance treatment assessment in clinical trials."

J Cosmet Dermatol. 2021 Apr; 20(Suppl 1): 28–31.
A novel azelaic acid formulation for the topical treatment of inflammatory rosacea: A multicentre, prospective clinical trial
Federica Dall’Oglio, MD, PhD,  Aurora Tedeschi, MD, PhD,  Francesco Lacarrubba, MD,  Gabriella Fabbrocini, MD, PhD,  Nevena Skroza, MD, PhD,  Paolo Chiodini, MS, Giuseppe Micali, MD

[17] "Oxidative status and NFC may play diagnostic and prognostic roles in rosacea, which should be confirmed by studies with larger sample sizes."
Evaluation of demodicosis, nailfold capillaroscopy, and oxidative stress in rosacea: a case-control study

[18] Skin Hydration Sensor (SHS)


[19] Clin Cosmet Investig Dermatol. 2021; 14: 1629–1636.
Increased Frequency of Circulating Classical Monocytes in Patients with Rosacea
Cuie Gao,  Lan Ge,  Dewei Chen,  Mengjie Zhang,  Li Zhao,  Wenying Liu,  Shuguang Chen,  Juan Wang,  Cunjian Zhou,  Xingwang Zhao,  Shifei Li,  Zhiqiang Song,  Jian Li 

[20] Redox Rep. 2016; 21(4): 164–169
Oxidative stress and antioxidant strategies in dermatology
Jinok Bae1 and Min-Geol Lee

[21] “In conclusion, PCT, MPV, and RDW have diagnostic value for rosacea, and RDW is correlated with the severity of rosacea erythema, implying the potential applications of PCT, MPV, and RDW in the diagnosis and monitoring of rosacea.” 


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"The proposed framework retrained by the dataset that represented the real clinical environment in our department could accurately classify most common dermatoses that we encountered during outpatient practice including infectious and inflammatory dermatoses, benign and malignant cutaneous tumors."

A Deep Learning Based Framework for Diagnosing Multiple Skin Diseases in a Clinical Environment

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