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Differential Diagnosis Of Rosacea

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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. Can you see why a dermatologist is better qualified to differentiate this list rather than asking a social media group of rosacea sufferers, i.e., Facebook or Reddit, and ask the question, 'IS THIS ROSACEA?'  Just because a patient presents with erythema 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: 

Acne @
Acne Agminata **
Acne Venenata*
Acne Vulgaris*
Actinic folliculitis
Actinic Reticuloid ^
Allergic Conjunctivitis @
Anaphylaxis !
Atopic dermatitis $
Autosensitization dermatitis [5]
Basal Cell Carcinoma +
Bromoderma **
Carcinoid Syndrome # [6]
Chronic discoid lupus erythematosus (CDLE) # [7]
Chronic Topical Corticosteroid Therapy ^
Crohn’s disease @@
Climacterum !
Colon Cancer @@
Contact and photocontact dermatitis $
Corticoid Damage*
Cutaneous Lupus Erythematosus (CLE) [7]
Cutaneous Rosai-Dorfman {1]
Discoid Lupus Erythematosus (DLE) [7]
Drug eruptions (particularly from iodides and bromides) %
Eosinophilic pustular folliculitis (EPF) [2]
Erysipelas ^
Erythema Infectiosum *
FACE syndrome @@
Fractional Microneedling Radiofrequency Induced Rosacea
Gram-negative Folliculitis*
Growth Factor Receptor Inhibitor “acne” +
Haber's syndrome #
Idiopathic facial aseptic granuloma (IFAG)
Iododerma **
Kaposi varicelliform eruption  (eczema herpeticum)
Keratosis Pilaris [4]
Lichen Spinulosus [4]
Lupus Erythematosus ^ [6]
Lupus Miliaris Disseminatus (Faciei)*
Lupus Vulgaris **
Mast cell activation syndrome
Mastocytosis Syndrome @
Medications $
Medullary Carcinoma of the Thyroid !
Melkerrson-Rosenthal syndrome [3]
Mitral Valve Incompetence **
Mixed Connective Tissue Disease [6]
Morbihan´s Disease*
Pancreatic cell tumor !
Perioral Dermatitis*
Periocular Dermatitis*
Pheochromocytoma !
Photodermatitis #
Photosensitivity diseases
Photosensitive Eruption [6]
Physical erythema $
Polycythemia Vera [6]
Polymorphous light eruption #
Polymyositis %
Pregnancy @@
Prosopitis Granulomatosa*
Pustular Folliculitis**
Pyoderma faciale &
Renal Carcinoma !
Rubeosis Diabeticorum*
Sarcoidosis **
Sarcoidosis, Small Nodular Type*
Seborrheic Dermatitis*
Secondary Lues*
Skin Granulomas %
Sterile Eosinophilc Pustulosis*
Steroid rosacea @@
Subacute Cutaneous Lupus Erythematosus SCLE*
Syphilis ^
Systemic Lupus Erythematosus @
Tuberculosis ^
Ulcerative Colitis @@
Ocular Rosacea Differential Diagnosis:
Sebaceous Gland Carcinoma %
Seborrheic Blepharokeratoconjunctivitis %
Staphylococcal Blepharokeratoconjunctivitis %
Systemic Mastocytosis [6]
Trichodysplasia spinulosa (TS) [4]

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.

Kajal B, Harvey J, Alowami S.

[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.
Published online 2018 Sep 15. doi: 10.7759/cureus.3310
PMCID: PMC7053793
PMID: 32175199
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

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