Rosacea or What is on Your Face?
An Editorial on the Confusion about Rosacea
by Brady Barrows
Please note: In my book, Rosacea 101, (published in October 2007) in Chapter 1, What is Rosacea?, page 1, and Chapter 2, Rosacea Mimics, page 9, you can read an updated version of what I wrote below which is the basis of both chapters. My new book is a comprehensive basic rosacea 101 knowledge for rosacea newbies who want to learn about the conventional and alternative treatments for rosacea.
If you have been following like I have throughout all the rosacea support groups the confusion and frustration of diagnosing rosacea or what skin condition a sufferer has developed, you will notice that the list of subtypes, variants and other skin conditions keeps growing and growing. Time and again rosaceans report that they may have simultaneously another skin condition or that what was originally diagnosed as rosacea actually turns out later diagnosed as something else. I have been keeping a list of the skin conditions that keep coming up that mimic rosacea and/or require a differential diagnosis from a physician and the list currently is forty skin conditions or diseases. If you know of another one I may have missed I would appreciate knowing about it and the source.
The NRS has tried to help resolve some of this confusion by classifying rosacea into four subtypes and one variant. There are also sources that list a total of five other variants, making a total of nine (I found six more, so the total makes 15). Of these one source lists one skin condition that is a 'secondary feature of rosacea.'
Here are the subtypes of rosacea:
(1) Erythematotelangiectatic (ETR)
(characterized by persistent redness)
(2) Papulopustular
(characterized by persistent redness with bumps [papules] and pimples [pustules])
The NRS only recognizes one variant, Granulomatous Rosacea. However, most medical literature discusses several other rosacea variants and there is no universal agreement of what constitutes a rosacea variant.
You can click here for a a partial list of photos.
If that isn't enough, I have complied a list of skin conditions or diseases that mimic rosacea, requiring a differential diagnosis by a qualified physician and here is the list:
Another report says, "In 2004 in an article appearing in the Journal of the American Academy of Dermatology, Crawford et al. proposed the concept of glandular rosacea to describe another phenotype distinct from the four subtypes introduced by the expert committee. Glandular rosacea occurs predominantly in males who characteristically have oily skin, large pores, a tendency to rhinophyma, and inflammatory lesions, including papules, pustules and nodulocystic lesions, that extend onto the lateral cheeks and neck." source This same report says, "Debate also continues over whether rosacea conglobata and rosacea fulminans are variants of acne vulgaris or rosacea."
As you can see the mystery and confusion of rosacea only adds to the frustration and we need more research. I have formed a tax exempt non profit for rosacea that has been approved as a 501 (c) (3) organization that allows rosaceans a say into what research should be undertaken that may clear up some of this confusion. For more information
go to http://www.irosacea.org
