How can I differentiate between acne rosacea and other similar skin conditions during a consultation?

Differentiating between acne rosacea and other similar skin conditions, such as acne vulgaris, during a consultation involves observing key clinical features and considering the patient's history ¹,².

• Presence of Comedones: A primary distinguishing factor is the presence of comedones (blackheads and whiteheads) in acne vulgaris, which are typically absent in rosacea (Libon et al., 2015) ².
• Lesion Characteristics:
  • Rosacea commonly presents with persistent facial erythema (redness), flushing, and visible blood vessels (telangiectasia) ¹. It may also include papules and pustules, but unlike acne, these are not associated with comedones ¹. Rosacea can also lead to skin thickening (phymatous changes, such as rhinophyma) and may involve the eyes, causing symptoms like dry eye, blepharitis, or more serious complications such as keratitis or anterior uveitis ¹.
  • Acne vulgaris is characterized by comedones, papules, pustules, nodules, and cysts, which can lead to scarring and persistent pigmentary changes ².
• Affected Areas: Rosacea primarily affects the central face, including the cheeks, nose, forehead, and chin ¹. Acne vulgaris can affect the face, back, and chest ².
• Triggers: Rosacea is often exacerbated by specific triggers such as sun exposure, heat, spicy foods, alcohol, and stress, which patients may identify by keeping a diary ¹. While diet can be a factor in acne vulgaris, specific triggers are less emphasized in the provided context ².
• Diagnostic Uncertainty and Skin of Colour: If there is diagnostic uncertainty for either condition, particularly in people with darker skin phototypes where features like erythema and telangiectasia may be difficult to detect in rosacea, referral to a dermatologist should be considered ¹ (Tan, 2017; Gallo, 2018; Alexis, 2019; Maruthappu and Taylor, 2022). A dermatoscope may be helpful in detecting telangiectasia in darker skin types for rosacea ¹ (Gallo, 2018; Alexis, 2019). For acne, persistent pigmentary changes are a reason for referral ².