Rosacea Mimics Photos

There is a lot of confusion about what is rosacea mainly because there are so many rosacea mimics. A physician has to take a patient history and a physical exam to obtain a differential diagnosis from a plethora of rosacea mimics. To understand how confusing this is let's first look at images of rosacea:

Rosacea Image Medscape

Rosacea - Image Mayo Foundation

Rosacea also usually manifests itself with the classic butterfly or T - Zone:

Image - e-medicum.com

Rosacea Butterfly with T Zone
Image - www.patient.co.uk

View the four Subtypes of Rosacea

The NRS 'expert committee' only recognizes one rosacea variant, Granulomatous Rosacea:

Granulomatous rosacea
Image Dermatology
Online Journal

So you think you know what rosacea looks like? Simple enough? Not necessarily so. It can be difficult for a trained dermatologist to differentiate rosacea from all the rosacea mimics.

First lets look at acne vulgaris and see how it mimics rosacea:

Acne close up of pustular leisons -
Image A.D.A.M.

Acne Blackheads - Image A.D.A.M.

Acne Vulgaris - Image A.D.A.M.

 

Now lets look at another of the rosacea mimics, Perioral Dermatitis:

Perioral Dermatitis - Image leobarco@yahoo.com

Perioral Dermatitis - Image A.D.A.M.

Notice how Candidiasis can present a similar presentation:

Candidiasis Cutaneous around the mouth
Image A.D.A.M.

Compare the above skin conditions to the one below:

Atopic Dermatitis - image www.lib.uiowa.edu

According to this source:

"Atopic dermatitis is a long-term skin disease. "Atopic" refers to a tendency to develop allergy conditions. "Dermatitis" means swelling of the skin.

The most common symptoms of atopic dermatitis are:

Dry and itchy skin
Rashes on the face, inside the elbows, behind the knees, and on the hands and feet.
Scratching the skin can cause:

Redness
Swelling
Cracking
"Weeping" clear fluid
Crusting
Thick skin
Scaling.
Often, the skin gets worse (flares), then it improves or clears up (remissions)."

It is not uncommon for rosacea and atopic dermatitis (eczema) to co-exist on the same patient.

Atopic Dermatitis
Image - femail.com.au

Atopic Dermatitis (Eczema) is a rosacea mimic that can be quite confusing with rosacea since as you can see above it looks just like it.

Medline Plus says, "Eczema is a term for several different types of skin swelling. Eczema is also called dermatitis. It is not dangerous, but most types cause red, swollen and itchy skin. Factors that can cause eczema include other diseases, irritating substances, allergies and your genetic makeup. Eczema is not contagious."

 

Another rosacea mimic is Seborrheic Dermatitis which looks like this:

Seborrheic Dermatitis - Image A.D.A.M.

Seborrheic Dermatitis - image www.lib.uiowa.edu

Notice how Keratosis Pilaris is so similar to rosacea:

Keratosis Pilaris - Image A.D.A.M.

Keratosis Pilaris - Image A.D.A.M.

Another rosacea mimic to consider is Pityrosporum Folliculitis:

Pityrosporum Folliculitis- Image skindoctor.pl

“Pityriasis folliculorum is an often over-looked clinical entity” and cases are ‘mostly female.’ He explains that there is ‘usually a history of rarely using soap or water to cleanse the facial skin but instead using cleansing creams.’ These individuals often apply moisturizers and complain of a burning or itchy sensation. He states that the diagnosis of PF is ‘facilitated by use of dermatoscopy, which shows a distinctive picture of the presence of multiple white keratotic material consisting of keratin encrusted demodex mites protruding upwards from the follicular orifices.’ This condition ’seems to be caused by an over population of mites facilitated by the frequent use of creams and the lack of face washing with soap and water.’
Source > Quote from my review of Frank Powell's book on rosacea management.

DemodicidosisDemodicidosis Image - www.consultantlive.com

Demodicidosis or demodectic rosacea can be easily confused with rosacea and a differential diagnosis should be done to rule it out. More info.

Tinea Faciale

Tinea Faciale - Image www.lib.uiowa.edu

Frank Powell, M.D., one of the foremost experts on rosacea suggests that every physician rule out Tinea Faciale before diagnosing rosacea since it mimics rosacea and requires a different treatment. The source showinge many images says:

"Tinea faciale is a common infection of the skin on the face caused by a fungus. The infection usually starts out as a red or pink patch, and the patch gradually becomes raised and itchy with the center of the patch appearing as normal skin. This ring-like appearance explains the nickname for tinea infections, ringworm, though this is a misnomer as there is no worm involved. The same fungus that causes tinea corporis (a body infection) causes tinea faciale. All tinea infections are spread from contact with infected people (children commonly spread tinea from one to another), infected animals, or contaminated personal objects such as towels. Tinea infections are relatively easy to treat with prescription creams or pills from your doctor. Because tinea infections are contagious, it is best to avoid intimate contact or sharing of towels or pillowcases with someone with a tinea infection."

5 Images of Tinea Faciale from DermIS

"Tinea faciei is the most frequently misdiagnosed entity among cutaneous fungal infections....other photodermatoses to consider include polymorphous light eruption, contact dermatitis, and rosacea."
TINEA FACIEI PRESENTING BUTTERFLY ERYTHEMA IN A BOY
Serpil Şen
European Journal of General Medicine, Vol. 4, No. 3, 2007, pp. 141-142 o

Check out Erysipelas, how it looks so much like rosacea:

Erysipelas - Image A.D.A.M.

Erysipelas produces a rash that is red, slightly swollen, very defined (well demarcated), warm, and tender to the touch. This individual has infection in the skin on both sides of the face, however, bilateral (both side) involvement is infrequent. Erysipelas may produce symptoms that affect the entire body (systemic) such as fever and chill. Erysipelas is a rosacea mimic. More info.

"The diagnosis of lupus flare was made by the general practioner who prescribed corticosteroids....and the patient was hospitalized....The diagnosis of erysipelas of the face was made...This coincidence is a rare condition which may lead to erroneous diagnosis and inappropriate therapy."
A red face in a lupus patient: thinking beyond lupus rash.
Stubbe M, Smith V, Thevissen K, Mielants H, De Keyser F.
Acta Clin Belg. 2010 Jan-Feb;65(1):44-7.

The next rosacea mimic is dermatomyositis:

Dermatomyositis - Image A.D.A.M.

This gives you an idea of how difficult it is for a dermatologist or physician to differentiate rosacea from rosacea mimics. A careful patient history, physicial exam, and possible tests can properly diagnose what skin disease you may be suffering from. Here is a list of other rosacea mimics which is a long list and more will no doubt continue to be added.