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Differential Diagnosis Of Rosacea


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If only we had a dream team like this to differentiate rosacea from the list below! 

Differential Diagnosis of Rosacea
Authoritative Resource Guide

Below is a list with sources showing differential skin disease(s) to consider in diagnosing rosacea when patients present with erythema, telangiectasia, or flushing. Can you see why a dermatologist is better qualified to differentiate the list below, rather than asking a social media group of rosacea sufferers, i.e., Facebook or Reddit, the question, 'IS THIS ROSACEA?' !

"The aetiology of facial rash is diverse, and the diagnosis is not always straightforward." [19]

Just because a patient presents with erythema, pimples/pustules, telangiectasia or flushing doesn't mean it is rosacea and should be differentiated from this list below, which by the way, is not an exhaustive list and will keep growing as we learn of new ones which we add to the list below with authoritative sources. If we have missed one, why not find the reply to this topic button and let us know about it. That is what rosaceans helping rosaceans is all about.  

A new approach on differentiating rosacea from other skin diseases is the Gate Recurrent Unit

Acne @
Acne Agminata ** [22]
Acne Venenata*
Acne Vulgaris* [17]
Actinic folliculitis
Actinic Reticuloid ^
Acute cutaneous lupus erythematosus [19]
Adenoma Sebaceum [27]
Allergic Conjunctivitis @
Amyloidosis [23]
Anaphylaxis !
Atopic dermatitis $
Autosensitization dermatitis [5]
Basal Cell Carcinoma +
Bloom's syndrome [23]
Bromoderma **
Calcinosis [24]
Carcinoid Syndrome # [6] [17] [23]
Cardiac Disease [23]
Chalazions [8]
Chronic discoid lupus erythematosus (CDLE) # [7]
Chronic Topical Corticosteroid Therapy ^
Crohn’s disease @@
Climacterum !
Colon Cancer @@
Contact and photocontact dermatitis $ [19]
Corticoid Damage*
CREST Syndrome [24]
Cutaneous adverse drug reactions (ADRs) [10]
Cutaneous Angiosarcoma
Cutaneous Coccidioidomycosis [25]
Cutaneous Lymphoma [17]
Cutaneous Lupus Erythematosus (CLE) [7]
Cutaneous Rosai-Dorfman [1]
Dermatomyositis* [17] [19] [24]
Discoid Lupus Erythematosus (DLE) [7]
Disseminated Idiopathic T-Cell Pseudolymphoma [27]
Drug Allergies [23]
Drug eruptions (particularly from iodides and bromides) %
Eosinophilic pustular folliculitis (EPF) [2]
Epidermal Growth Factor Receptor Inhibitor Drug Eruptions [17]
Erysipelas ^
Erythema Infectiosum *
Erythema perstans faciei [24]
Erythromelagia (EM)
Exophiala oligosperma
Extranodal Rosai-Dorfman [11]
FACE syndrome @@
Follicular mucinosis [9]
Folliculitis [14]
Fractional Microneedling Radiofrequency Induced Rosacea
Gram-negative Folliculitis*
Growth Factor Receptor Inhibitor “acne” +
Haber's syndrome #
Hyperpigmentation (PIH) [18]
Idiopathic facial aseptic granuloma (IFAG)
Indeterminate cell histiocytosis (ICH)
Infectious diseases [23]
Jessner's lymphocytic infiltrate of the skin (JLIS) [27]
Kaposi varicelliform eruption  (eczema herpeticum)
Keratinization [23]
Keratosis Pilaris [4]
Keratosis Pilaris Atrophicans Faciei (KPAF)
Iatrogenic Rosacea [12]
Lichen Spinulosus [4]
Iododerma **
Lupoid leishmaniasis
Lupus Erythematosus ^ [6]
Lupus Miliaris Disseminatus (Faciei)* [17]
Lupus Vulgaris **
Lymphoma [23]
Malar rash
Malassezia folliculitis
MARSH Syndrome [26]
Mast cell activation syndrome
Mastocytosis Syndrome @
Measles Virus [15]
Medications $
Medication-induced facial erythema (eg topical or systemic corticosteroids) [19]
Medullary Carcinoma of the Thyroid !
Melkerrson-Rosenthal syndrome [3]
Mitral Valve Incompetence **
Mixed Connective Tissue Disease [6]
Morbihan´s Disease*
Mycosis fungoides (MF) [29]
Neoplasia [23]
Netherton syndrome [16]
Pancreatic cell tumor !
Perioral Dermatitis*
Periocular Dermatitis*
Pheochromocytoma !
Photodermatitis #
Photosensitivity diseases
Photosensitive Eruption [6]
Physical erythema $
Pityriasis folliculorum
Pityrosporum Follicultis
Poikiloderma [20]
Polycythemia Vera [6]
Polymorphous light eruption # [17] [27]
Polymyositis %
Porphyrias [23]
Post-Inflammatory Erythema (PIE) [18]
Pregnancy @@
Primary cutaneous marginal zone lymphoma (PCMZL)
Prosopitis Granulomatosa*
Pseudolymphoma [27]
Pustular Folliculitis**
Pyoderma faciale &
Renal Carcinoma !
Rosaceiform Dermatitis [13]
Rosai-Dorfman disease (extranodal)
Rubeosis Diabeticorum*
Sarcoidosis ** [23]
Sarcoidosis, Small Nodular Type*  
Sarcoidosis (papular) [27]
Sebaceous Gland Carcinoma %
Seborrheic Blepharokeratoconjunctivitis %
Seborrheic Dermatitis* [17]
Secondary Lues*
Sensitive Skin
Skin Granulomas %
Sterile Eosinophilc Pustulosis*
Steroid rosacea @@
Subacute Cutaneous Lupus Erythematosus SCLE*
Sweet syndrome
Syphilis ^
Systemic Lupus Erythematosus @ [17]
Systemic Mastocytosis [6]
Tinea Faciei [19]
Topical Steroid–Induced Acne [17]
Trichoblastoma [28]
Trichodysplasia spinulosa (TS) [4]
Tuberculosis ^
Tyrosinase Kinase Inhibitor Drug Eruptions [17]
Ulcerative Colitis @@

End Notes
# Journal of the Royal Society of London, Vol. 90, March, 1997, p.247
@ American Family Physician, August 1, 2002
$ Diagnosis and Treatment of Rosacea, Aaron F. Cohen, MD, and Jeffrey D. Tiemstra, M, J Am Board Fam Pract 2002;15:214 –7.)
% Treatment of Acne Rosacea Reviewed CME/CE, Laurie Barclay, MD, Charles Vega, MD, FAAFP, MedscapeCME Clinical Briefs
^ Acne Rosacea, Marian S. Macsai, Mark J. Mannis, and Arthur C. Huntley, 1996 by Lippincott-Raven Publisher
** Rosacea: Differential Diagnoses & Workup, Agnieszka Kupiec Banasikowska, MD, Saurabh Singh, MD, eMedicine from WebMD
+ Rosacea, Guy F. Webster, MD, PhD, Medical Clinics of North America - Volume 93, Issue 6 (November 2009)
! The flushing patient: Differential diagnosis, workup, and treatment, Leonid Izikson, MD, Joseph C. English III, MD, Matthew J. Zirwas, MD. Journal of the American Academy of Dermatology - Volume 55, Issue 2 (August 2006)
& DermNet NZ
@@ Rosacea: A Review, Brittney Culp, BA and Noah Scheinfeld, MD, P&T, 2009 January; 34(1): 38–45.

[1] Cutaneous Rosai-Dorfman disease presenting as a granulomatous rosacea-like rashs.
Shi XY, Ma DL, Fang K.
Chin Med J (Engl). 2011 Mar;124(5):793-4.

[2] J Dermatol. 2013 Mar 12. doi: 10.1111/1346-8138.12125. 
Clinical and histopathological differential diagnosis of eosinophilic pustular folliculitis.
Fujiyama T, Tokura Y.

Infection. 2020 Nov 25;:
Eosinophilic pustular folliculitis (EPF) in a patient with HIV infection.
Kanaki T, Hadaschik E, Esser S, Sammet S

Kajal B, Harvey J, Alowami S.
Allergy Asthma Clin Immunol. 2019 Jan 5;15:1. doi: 10.1186/s13223-018-0316-z.  eCollection 2019.
Melkersson-Rosenthal Syndrome: A Case Report of a Rare Disease With Overlapping Features
Mauro Cancian, Stefano Giovannini, Annalisa Angelini, Marny Fedrigo, Raffaele Bendo, Riccardo Senter, Stefano Sivolella 

Dermatol Online J. 2020 Jun 15;26(6):
Morbihan disease: a case report and differentiation from Melkersson-Rosenthal syndrome.
Kuraitis D, Coscarart A, Williams L, Wang A

[4] "The differential diagnosis of TS can be broad, including keratosis pilaris and related disorders, lichen spinulosus, sarcoidosis, rosacea, and perforating disorders."
JAAD Case Rep. 2019 Apr; 5(4): 352–354.
Published online 2019 Apr 5. doi: 10.1016/j.jdcr.2019.02.001
PMCID: PMC6453831
Widespread keratosis pilaris–like eruption in an immunocompromised child
Alice Frigerio, MD, PhD, Tuna Toptan, MD, PhD, Yuan Chang, MD, James Abbott, MD, Sarah D. Cipriano, MD, and Anneli R. Bowen, MD

[5] JAAD Case Rep. 2019 May; 5(5): 410–412.
Autosensitization dermatitis: A case of rosacea-like id reaction
Sarah D. Ferree, BA, Connie Yang, BA, and Arianne Shadi Kourosh, MD, MPH
[6] According to Izikson et al, "When evaluating patients with rosacea, it is important to exclude the diagnoses of polycythemia vera, photosensitive eruption, lupus erythematosus, mixed connective tissue disease, carcinoid syndrome, systemic mastocytosis, or side effects from long-term facial application of topical steroids."
Blushing Propensity and Psychological Distress in People with Rosacea.
Su D, Drummond PD.
Clin Psychol Psychother. 2011 Jun 23. doi: 10.1002/cpp.763.
[7] "Discoid lupus erythematosus (DLE) represents a common form of cutaneous lupus erythematosus (CLE) that often prompts dermatologic consultation....In turn, lymphohistiocytic infiltrates in CLE have rarely been reported in the literature, and when arising on the H-zone of the face, this represents a recognizable guise that could be misconstrued as acne/rosacea."
Cureus. 2018 Sep; 10(9): e3310.
Histiocyte-rich Discoid Lupus Erythematosus: A Peculiar Perifollicular Distribution Histologically Mimicking an Acneiform Disorder
Monitoring Editor: Alexander Muacevic and John R Adler
Ryan M McKee, Amanda F Marsch, and Brian R Hinds
Discoid lupus erythematosus (DLE) and and rosacea share common features in etiopathogenesis and clinical presentation. These two diseases can be seen concomitant, mimic each other clinically and share common possible etiologic factors.

Dermatol Ther. 2020 Apr 10;:e13394
Demodex positive discoid lupus erythematosus: Is it a separate entity or an overlap syndrome?
Dursun R, Durmaz K, Oltulu P, Ataseven A

[8] "In case of multiple recurrent chalazia in a child, ametropia and ocular rosacea should be ruled out."

Rev Prat. 2019 Oct;69(8):881-883
Recurrent chalazions in children
Doan S

[9] JAAD Case Rep. 2020 Apr; 6(4): 266–272.
Published online 2020 Mar 24. doi: 10.1016/j.jdcr.2020.01.014. PMCID: PMC7109359
Demodex-induced follicular mucinosis of the head and neck mimicking folliculotropic mycosis fungoides
Megan H. Trager, BA, Dawn Queen, BA, Diane Chen, MD, Emmilia Hodak, MD, Larisa J. Geskin, MD

[10] "Clinical manifestations, which range from milder erythematous to urticarial reactions to severe lethal anaphylaxis, may be indistinguishable from immune system-mediated hypersensitivity reactions."

Clinical and Basic Immunodermatology. 2017 Apr 25 : 439–467.
Published online 2017 Apr 25. doi: 10.1007/978-3-319-29785-9_25. PMCID: PMC7123512
Adverse Medication Reactions
Anthony A. Gaspari, Stephen K. Tyring, Daniel H. Kaplan

[11] Int J Clin Exp Pathol. 2020;13(3):556-558
Granulomatous rosacea-like skin rash: extranodal Rosai-Dorfman disease.
Shen HP, Lu ZF, Zhu JW

[12]  Indian Dermatol Online J. 2013 Apr-Jun; 4(2): 133–142.
Paradoxes in dermatology
Keshavmurthy A. Adya, Arun C. Inamadar, and Aparna Palit

[13] J Am Acad Dermatol. 2010 Jun;62(6):1050-2. doi: 10.1016/j.jaad.2009.01.029.
Rosaceiform dermatitis associated with topical tacrolimus treatment.
Fujiwara S, Okubo Y, Irisawa R, Tsuboi R.

[14] Folliculitis - Another Rosacea Mimic

Aust Prescr 2018;41:20-4, 1 February 2018, DOI: 10.18773/austprescr.2018.004
An update on the treatment of rosacea
Alexis Lara Rivero, Margot Whitfeld

DermNet NZ lists rosacea as an acne like variant in a differential diagnosis of folliculitis

[15]  "A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms." Measles, Wikipedia

[16] "At his most recent follow-up after almost 3 years of treatment with secukinumab, he had complete clearance of his facial erythema and only 1 mild flare of the polycyclic plaques on his trunk and extremities several months before."
JAAD Case Rep. 2020 Jun; 6(6): 577–578.
Successful use of secukinumab in Netherton syndrome
Sarah K. Blanchard, MD and Neil S. Prose, MD

[17] Cutis. 2014 July;94(1):39-45
The Great Mimickers of Rosacea
Jeannette Olazagasti, BS; Peter Lynch, MD; Nasim Fazel, MD, DDS

Case Rep Dermatol. 2021 May-Aug; 13(2): 321–329.
Lupus Miliaris Disseminatus Faciei versus Granulomatous Rosacea: A Case Report
Ji-In Seo and Min Kyung Shin

[18] "Post-Inflammatory Erythema (PIE) and Hyperpigmentation (PIH) are not exactly the same thing. Post-inflammatory Hyperpigmentation (PIH) is brown or black marks caused by an inflammatory reaction producing an overproduction of melanin. Causes include getting a pimple, aging, pregnancy (melasma), hormones, and sun exposure.  Post Inflammatory Erythema (PIE) refers to the red or purplish marks left behind from acne. The redness is from damage or dilation done to capillaries near the surface of the skin resulting in small flat red marks. Patients can have a combination of both PIE and PIH."

J Clin Aesthet Dermatol. 2013 Sep; 6(9): 46–47.
Easy as PIE (Postinflammatory Erythema)
Yoon-Soo Cindy Bae-Harboe, MD, Emmy M. Graber, MD

J Clin Aesthet Dermatol. 2010 Jul; 3(7): 20–31.
Postinflammatory Hyperpigmentation
A Review of the Epidemiology, Clinical Features, and Treatment Options in Skin of Color
Erica C. Davis, MD, Valerie D. Callender, MD

[19] Aust J Gen Pract. 2020 Jan-Feb;49(1-2):36-37
A new facial rash.
Sun C, Muir J

[20] Poikiloderma is "most frequently seen on the chest or the neck, characterized by red colored pigment on the skin that is commonly associated with sun damage." Wikipedia

It was reported by Tont at RF that someone said it was either Poikiloderma or Rosacea.

[22] An Bras Dermatol. 2020 Nov-Dec; 95(6): 754–756.
Case for diagnosis. Eyelid edema and erythematous papules disseminated on the face⋆⋆⋆
Ana Cristina M. Garcia, Ângela Marques Barbosa, Marilda Aparecida Milanez Morgado de Abreu, and Carlos Zelandi Filhoc

[23] is (Bern 1994). 2004 Oct 13;93(42):1727-32.
[The red face]
Ch Schuster, G Burg

[24] Clin Dermatol. Jan-Feb 2014;32(1):153-8.  doi: 10.1016/j.clindermatol.2013.05.037.
The red face revisited: connective tissue disorders
Jana Kazandjieva, Nikolai Tsankov, Kyrill Pramatarov

[25] Int J Womens Dermatol. 2020 Dec; 6(5): 458–459.
Recalcitrant facial rash: Cutaneous coccidioidomycosis
Shanice A. McKenzie, BS,a Amy R. Vandiver, MD, PhD,b Natalie M. Villa, MD,b Chandra N. Smart, MD,c Vivian Y. Shi, MD,d and Jennifer L. Hsiao, MD

[26] Viewpoints in Dermatology
The red face—an overview and delineation of the MARSH syndrome
W. A. D Griffiths
St John’s Institute of Dermatology, London, UK


[27] Indian Dermatol Online J. 2021 Mar-Apr; 12(2): 312–315.
The Puzzle of Papules Over Face and Extrafacial Areas: A Rare Case of Disseminated Idiopathic T-Cell Pseudolymphoma
Sumit A. Hajare, Vaishali H. Wankhade, Gitesh U. Sawatkar, and Rajesh Pratap Singh

[28] Am J Case Rep. 2021; 22: e932320-1–e932320-4.
Extensive Facial Trichoblastoma – A Rare and Disfiguring Condition
Siti Nur Hidayah Abd Rahim, Nur Ashikin Ahmad, and Mohamed-Syarif Mohamed-Yassin

[29] "Some new clinical presentations that may be imitated by MF are also presented in Table 1, including keratosis punctata palmaris, seborrheic dermatitis, angular cheilitis, psoriasis inversa, rosacea, varicous eczema. Furthermore, some particular localizations of MF lesions and a series of dermatoses developing in preexisting MF lesions are presented."

Dermatol Ther (Heidelb). 2021 Dec; 11(6): 1931–1951.
A Comprehensive Update of the Atypical, Rare and Mimicking Presentations of Mycosis Fungoides
Eve Lebas, Patrick Collins, Joan Somja, and Arjen F. Nikkels

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