If I had £1 for every instagram DM I get from someone asking ‘do I have rosacea?’ followed by a flood of photos of their skin, I would be writing this blog post from a luxury beach hut (fully air-conditioned, shady, and with a huge fan pointed at me… of course!) I am not medically or aesthetically trained but I know the panic and hopelessness a person can feel when they are waist-deep in rosacea research and feeling even more confused than when they started. So I wanted to try to help…
Some of the information in this post has been rephrased from a blog post I wrote 3 years ago, which you can read here, but I wanted to see if I could make it clearer. I get questions all the time – on social media and in my private Facebook group – where people are so unsure if they have rosacea. They’ve read all the information they can find, they’ve seen and heard other sufferers’ experiences, they’ve tried to fit their symptoms into the common descriptions of what rosacea looks and feels like… but they’re still confused.
So I thought it would help you to see how rosacea is *clinically* diagnosed. This information is taken from this article on Rosacea.org but it’s pretty dense and hard to read, so I summarised it for you below.
Let’s cover the background first shall we? Since 2002, we have categorised rosacea into 4 subtypes:
- Subtype 1 (erythematotelangiectatic) – redness, visible broken veins, and flushing.
- Subtype 2 (papulopustular) – redness and fluid-filled pimple and itchy bumps (sometimes unhelpfully known as acne rosacea).
- Subtype 3 (Rhinophyma/Phymatous) – a thickening of the skin, usually on the nose.
- Subtype 4 (ocular rosacea) – characterised by red and sore eyes that often feel gritty.
- There is also a Subtype 5 (neurogenic rosacea) which is rare and still very misunderstood. You can read more about it here.
If you’ve done any kind of research into rosacea, these will be familiar to you. Often rosacea sufferers will refer to themselves as type 1 or type 2, using this as a catch-all description. However, sufferers and doctors alike have found that these neat little boxes with labels are often hard to diagnose. Which is why healthcare professionals are moving more towards phenotypes when it comes to rosacea diagnosis.
These phenotypes are split into DIAGNOSTIC, MAJOR and SECONDARY:
- DIAGNOSTIC PHENOTYPES – To put it simply, if you present with either persistent facial redness or facial skin thickening, this is now enough to get a rosacea diagnosis.
- MAJOR PHENOTYPES – Papules and pustules, flushing, telangiectasia (broken veins) and certain ocular manifestations. Major phenotypes often accompany the above diagnostic phenotypes, however even if neither of the diagnostic phenotypes are present, you can still be diagnosed with rosacea if you present with at least two of the major phenotypes.
- SECONDARY PHENOTYPES: Burning or stinging, swelling (oedema) and dry appearance. These symptoms are not necessary for diagnosis and are not considered enough to form a diagnosis in isolation.
I’ve put these into a handy flowchart for those of you who prefer a quiz or visual format:
Obviously, it should go without saying that, this is not a diagnosis in itself. You should get a definitive diagnosis from your HCP just in case – rosacea can present like many other conditions and it’s always a good idea to be certain you are treating your skin in the right way.
I hope you found this post useful. Have a look below for what to read next if you’re looking for more rosacea information, recommendations, and advice.
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