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 ¹.

• Uncertain Diagnosis: Referral is appropriate if there is an uncertain diagnosis of rosacea ¹.
• Persistent Erythema: Consider referral for persistent erythema that has not responded to optimal management in primary care ¹.
• 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 ¹. These cases may require specialist treatment such as oral isotretinoin ¹.
• Severe Telangiectasia: Referral can also be considered for severe telangiectasia that have not responded to self-management advice ¹.

Additionally, for comprehensive management of rosacea, other specialist referrals may be considered ¹. A local skin camouflage service, which may be available through dermatology, can be considered ¹. Referral to a plastic surgeon is appropriate for prominent non-inflamed phymatous disease ¹. 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 ¹.