When should I consider referring a patient with acne rosacea to a dermatologist for further evaluation?

You should consider referring a patient with rosacea to a dermatologist for further evaluation in several specific situations NICE CKS.

• Uncertain Diagnosis: Referral is appropriate if there is an uncertain diagnosis of rosacea NICE CKS.
• Persistent Erythema: Consider referral for persistent erythema that has not responded to optimal management in primary care NICE CKS.
• Persistent Inflammatory Papules and/or Pustules: Referral is indicated if persistent inflammatory papules and/or pustules have not responded to optimal management in primary care, especially after combination therapy including oral tetracyclines NICE CKS. These cases may require specialist treatment such as oral isotretinoin NICE CKS.
• Severe Telangiectasia: Referral can also be considered for severe telangiectasia that have not responded to self-management advice NICE CKS.

Additionally, for comprehensive management of rosacea, other specialist referrals may be considered NICE CKS. A local skin camouflage service, which may be available through dermatology, can be considered NICE CKS. Referral to a plastic surgeon is appropriate for prominent non-inflamed phymatous disease NICE CKS. For suspected serious eye complications, such as keratitis or anterior uveitis, or other severe ocular symptoms not responding to optimal primary care management, an ophthalmologist referral is necessary NICE CKS.