How Rosacea Is Diagnosed

If you have persistent or recurrent redness on your face, an appearance of tiny superficial blood vessels on your cheeks and forehead, or dry, bloodshot eyes, you could have rosacea. 

Be sure to see a healthcare provider about it because the condition could cause lasting cosmetic changes or it could even affect your eyes and eyesight. And, if you haven’t been definitively diagnosed with rosacea yet, it’s possible that your symptoms could be due to another condition that requires its own treatment plan. So it’s important that you and your healthcare provider get to the bottom of your diagnosis. 

Self-Checks/At-Home Testing 

When you have signs of rosacea, such as pink bumps and telangiectasia (visible blood vessels) on your face, be sure to pay attention to recent changes in your diet or environment. Keep track of these things because they could be triggers. 

You also need to check other areas of your skin—such as your hands, legs, back, and neck—to know if you have other lesions besides those on your face.

Recognizing Flare-Ups

If you’ve already been diagnosed with rosacea, you can have some ups and downs with the condition. Not only will your rosacea vary a little over time, but you can also experience bouts when the effects are more prominent due to triggers like sun exposure, or spicy food, or inhalation of cigarette smoke (due to your own smoking or via secondhand smoke). 

Check Your Eyes

Rosacea can affect the eyes and/or eyelids, causing dryness, discomfort, swelling, redness, and cysts. This condition, described as ocular rosacea, can damage your vision if left untreated. If you have any of the signs of rosacea, be sure to look at your eyes carefully and tell your healthcare provider about any problems with your eyes. 

Physical Examination 

Typically, rosacea is diagnosed based on a physical examination. There is no specific test that can rule in or rule out the condition.

Your healthcare provider will look at the areas of your skin that you are complaining about and inspect other areas of your skin as well. Your healthcare provider will also examine your eyes or send you to a specialist for an eye examination. 

There are four types of rosacea, and they each correspond to the pattern of skin or eye changes.

Erythematotelangiectatic Rosacea 

Also described as type one or vascular rosacea, this is one of the more common types of rosacea. Flat patchy areas of redness on the cheeks and forehead are the predominant symptom with this type of rosacea. Small blood vessels may be visible, and the symptoms tend to be persistent, although they can also flare up and worsen at times.

Papulopustular Rosacea

This type is often designated as type two or inflammatory rosacea. The patchy areas of redness are characterized by tiny bumps that may or may not be filled with pus.

The most commonly affected areas are the skin on the cheeks, forehead, chin, and neck. The lesions often appear similar to pimples, and the condition can be mistaken for acne.

Phymatous Rosacea

Type three rosacea is the least common. It is characterized by hardened or swollen bumpiness of the skin, possibly with scarring and discoloration. Rhinophyma, a thickened nose, may develop, especially in older men who have the condition.

Ocular Rosacea

Type four rosacea affects the eyes and eyelids, and may or may not affect the skin as well. Eyes can feel dry, itchy, or you may have a burning sensation. With ocular rosacea, your eyes can be watery or red with prominent vessels (bloodshot) or may have bumpy cysts.

Labs and Tests

Diagnostic tests do not verify the diagnosis of rosacea. But you might need to have special tests to rule out another condition. Or you may need medical testing if your healthcare provider is concerned that your rosacea is part of a systemic illness. 

Your diagnostic tests can include: 

• Complete blood count (CBC) or erythrocyte sedimentation rate (ESR): Lupus is among the illnesses that can cause facial redness. Inflammatory conditions and autoimmune diseases, like rheumatoid arthritis, can be associated with rosacea. Your white blood cell count (WBC), which is measured by CBC, can be elevated with inflammatory disease. And ESR, which is measured by a specialized blood test, can be elevated with autoimmune conditions like rheumatoid arthritis and lupus.
• Allergy testing: Skin prick testing is a method by which your healthcare provider would evaluate your skin’s reaction to various substances that are applied directly to your skin. This test would be considered if the pattern of your lesions seems to be associated with an allergic response. 
• Skin biopsy: While it is rare to have a skin biopsy to diagnose rosacea, you may need one if one or more of your skin lesions has an unusual shape or texture, which raises a concern for skin cancer. 

Differential Diagnosis 

A number of medical problems can have an appearance similar to rosacea, and your healthcare provider will want to make sure to rule out these other possibilities. Typically, the distinction is established based on the physical examination of your skin and your history of symptoms. 

Conditions that can be considered in the evaluation of rosacea include: 

Acne: Papulopustular rosacea is characterized bumps that look like acne. Often, the age of a person and the personal history of acne can help in discerning the diagnoses.

Allergies: Skin contact, food ingestion, or inhaled airborne substances can trigger an allergic skin reaction that may look like rosacea. It may be hard to know if you have rosacea or an allergy. Generally, with rosacea, the skin condition does not completely resolve, whereas it can completely resolve after an allergic reaction. A skin prick test may provide the answer.

Dermatitis: Sometimes there is no explanation for dermatitis, and it can occur with varied patterns. The trademark facial pattern of rosacea can help distinguish these similar conditions.

Eczema: A condition that may affect the face or hands, eczema is often associated with abrasive materials.

Psoriasis: A skin condition in which patchy areas of skin become thickened, the appearance and texture of the lesions can help distinguish psoriasis from rosacea.

Lupus: This autoimmune disease can cause a pattern of facial flushing affecting the cheeks and forehead. The facial flushing of lupus tends to be flat and without telangiectasia. There is some overlap between rosacea and lupus, as they can occur together or with other inflammatory conditions.

Sunburn: Because sun exposure can exacerbate rosacea, it can be hard to know if you have a sunburn or a flare-up of your rosacea. Sunburn may be more painful and can cause peeling or tan skin, while rosacea should not do that.

A Word From Verywell

When the effects of rosacea are just starting, your diagnosis might not be clear. Once you are diagnosed with rosacea, your challenge lies in recognizing flare-ups and triggers so you can minimize the impact of the condition.