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Differential Diagnosis Of Rosacea

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If we could only have a diagnostic 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?'  Just because a patient presents with erythema, 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 sources : 

Acne @
Acne Agminata **
Acne Venenata*
Acne Vulgaris* [17]
Actinic folliculitis
Actinic Reticuloid ^
Allergic Conjunctivitis @
Anaphylaxis !
Ataxia–telangiectasia
Atopic dermatitis $
Autosensitization dermatitis [5]
Basal Cell Carcinoma +
Bromoderma **
Carcinoid Syndrome # [6] [17]
Cellulitis
Chalazions [8]
Chronic discoid lupus erythematosus (CDLE) # [7]
Chronic Topical Corticosteroid Therapy ^
Crohn’s disease @@
Climacterum !
Colon Cancer @@
Contact and photocontact dermatitis $
Corticoid Damage*
Cutaneous adverse drug reactions (ADRs) [10]
Cutaneous Lymphoma [17]
Cutaneous Lupus Erythematosus (CLE) [7]
Cutaneous Rosai-Dorfman [1]
Demodicidiosis*
Dermatomyositis* [17]
Discoid Lupus Erythematosus (DLE) [7]
Drug eruptions (particularly from iodides and bromides) %
Eosinophilic pustular folliculitis (EPF) [2]
Epidermal Growth Factor Receptor Inhibitor Drug Eruptions [17]
Erysipelas ^
Erythema Infectiosum *
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 #
Idiopathic facial aseptic granuloma (IFAG)
Kaposi varicelliform eruption  (eczema herpeticum)
Keratosis Pilaris [4]
Iatrogenic Rosacea [12]
Lichen Spinulosus [4]
Iododerma **
Lupoid leishmaniasis
Lupus Erythematosus ^ [6]
Lupus Miliaris Disseminatus (Faciei)* [17]
Lupus Vulgaris **
Malar rash
Malassezia folliculitis
Mast cell activation syndrome
Mastocytosis Syndrome @
Measles Virus [15]
Medications $
Medullary Carcinoma of the Thyroid !
Melkerrson-Rosenthal syndrome [3]
Mitral Valve Incompetence **
Mixed Connective Tissue Disease [6]
Morbihan´s Disease*
Netherton syndrome [16]
Pancreatic cell tumor !
Pellagra
Perioral Dermatitis*
Periocular Dermatitis*
Pheochromocytoma !
Photodermatitis #
Photosensitivity diseases
Photosensitive Eruption [6]
Physical erythema $
Pityriasis folliculorum
Pityrosporum Follicultis
Polycythemia Vera [6]
Polymorphous light eruption # [17]
Polymyositis %
Pregnancy @@
Prosopitis Granulomatosa*
Pustular Folliculitis**
Pyoderma faciale &
Renal Carcinoma !
Rhinophyma*
Rosaceiform Dermatitis [13]
Rosai-Dorfman disease (extranodal)
Rubeosis Diabeticorum*
Sarcoidosis **
Sarcoidosis, Small Nodular Type*
Sebaceous Gland Carcinoma %
Seborrheic Blepharokeratoconjunctivitis %
Seborrheic Dermatitis* [17]
Secondary Lues*
Skin Granulomas %
Sterile Eosinophilc Pustulosis*
Steroid rosacea @@
Subacute Cutaneous Lupus Erythematosus SCLE*
Sweet syndrome
Syphilis ^
Systemic Lupus Erythematosus @ [17]
Systemic Mastocytosis [6]
Topical Steroid–Induced Acne [17]
Trichodysplasia spinulosa (TS) [4]
Tuberculosis ^
Tyrosinase Kinase Inhibitor Drug Eruptions [17]
Ulcerative Colitis @@

End Notes
*DermIS
# 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.

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 

[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

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