The diagnosis of rosacea is recognized by primary and secondary features.

Primary Features For The Diagnosis of Rosacea

- rosacea affects convexities of central face. The signs are commonly transient and each may occur independently. Patients may be present with one or more of these diagnostic features.

Flushing (transient erythema) – a history of frequent blushing or flushing is common.

Nontransient erythema – persistent redness of the facial skin in the most common sign.

Papules and pustules - dome shaped red papules with or without accompanying pustules are typical. Nodules may also occur. However, comedones are unrelated to rosacea.

Telangiectasia – telangiectasia are common but not necessary for a rosacea diagnosis.

Secondary Features For The Diagnosis of Rosacea

- the following sign and symptoms often appear with one or more of the primary features of rosacea, but in some patients it can occur independently.

Burning or stinging – burning or stinging sensation with or without scaling or dermatitis may occur especially on malar skin [79].

Plaque – elevated red plaques without epidermal changes in surrounding skin may occur.

Dry appearance – central facial skin may be rough and scaling to resemble dry skin and suggest an eczematous dermatitis and may be with seborrheic dermatitis. The `dryness’ may be associated with burning or stinging sensations.

Edema – edema may accompany or follow prolonged facial erythema for flushing. Sometimes soft edema may last for days or be aggravated by inflammatory changes. Solid facial edema (persisting hard, nonpitting edema) can occur with rosacea usually as a sequel of papulopustular type and also independently of redness, papules and pustules or phymatous changes.

Ocular manifestations – ocular manifestations are common and range from symptoms of burning or itching to signs of conjunctival hyperemia and lid inflammation. Styes, Chalazia and corneal damage may occur in addition to cutaneous stigmata.

Peripheral location – rosacea has been reported to occur in other locations [90] but the frequency and occurrence of this are ill defined. Rosacea in peripheral locations may or may not be accompanied by facial manifestations.

Phymatous changes – these can include patulous follicles, skin thickening or fibrosis and a bulbous appearance. Rhinophyma is the most common form but other phymas may occur [130].

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