Diagnose It: Burning & Stinging

NEWS/ QUIZ

2 MIN QUIZ

A 65-year-old woman is referred to a dermatologist by her PCP for a skin cancer screening. The patient is concerned with the burning and stinging sensations she has felt on and off in her face for years. Upon further discussion, the dermatologist learns that these symptoms have accompanied previous recurrent, persistent redness. The patient believed these symptoms were due to a lack of sun protection combined with living in Florida. Due to a fear of skin cancer, the patient began wearing sun protection the year prior and has reported milder episodes of persistent redness.

Diagnostic Quiz: Rosacea: Burning and Stinging Symptoms

Based on this history, what is the correct diagnosis?

Select the correct answer

A) Rosacea

B) Sun burns/chronic sun damage

C) Contact dermatitis (eczema)

D) Systemic lupus erythematosus (SLE)

CORRECT

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INCORRECT

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Answer is: A

Evidence shows that burning and stinging are reported by 14% to 100% of patients across all rosacea subtypes. Patient surveys have found the symptoms of rosacea, such as burning and stinging, are significantly associated with a high burden of disease.¹

A recently published review article focused on the history of burning and stinging symptoms in rosacea explains that diagnosing rosacea has evolved to include nonvisible symptoms, which can occur in any patient with rosacea, in addition to traditional visual manifestations.¹

2013: The American Acne and Rosacea Society (AARS) proposed a phenotype approach to better diagnose and treat rosacea patients for all signs and symptoms experienced²
2017: The global ROSacea COnsensus (ROSCO) panel recommended a phenotype-based approach to diagnosing rosacea to improve outcomes in all patients by individualizing management³
2019: The ROSCO panel incorporated burning and stinging as secondary diagnostic criteria of rosacea in updated guidelines, to be considered as part of any severity assessment⁴

The potential causes and triggers of stinging and burning symptoms of rosacea include¹:

Neurovascular dysregulation
Demodex mite proliferation
Damage to the epidermal barrier (especially PPR)
Rosacea treatments can induce burning and stinging

A report published in 2018 provided new insights into rosacea and highlighted that the symptoms of rosacea are different from person to person, and the invisible symptoms are burdensome to the affected individual.⁵ To address this gap in care for rosacea patients, the 2019 ROSCO panel highlighted the need for consistent QoL and severity assessments that include burning and stinging that can help guide treatment for rosacea.⁴

References:

1. Schaller M, Dirschka T, Lonne-Rahm SB, et al. The importance of assessing burning and stinging when managing rosacea: a review. Acta Derm Venereol. 2021;101(10):adv00584. doi:10.2340/actadv.v101.356

2. Del Rosso JQ, Thiboutot D, Gallo R, et al. Consensus recommendations from the American Acne & Rosacea Society on the management of rosacea, part 1: a status report on the disease state, general measures, and adjunctive skin care. Cutis. 2013;92(5):234-240.

3. Schaller M, Almeida LM, Bewley A, et al. Rosacea treatment update: recommendations from the global ROSacea COnsensus (ROSCO) panel. Br J Dermatol. 2017;176(2):465-471. doi:10.1111/bjd.15173

4. Schaller M, Almeida LMC, Bewley A, et al. Recommendations for rosacea diagnosis, classification and management: update from the global ROSacea COnsensus 2019 panel. Br J Dermatol. 2020;182(5):1269-1276. doi:10.1111/bjd.18420

5. Tan J, Steinhoff M, Bewley A, Gieler U. The BMJ Hosted Content 2018. Rosacea: beyond the visible. Accessed February 3, 2022. https://hosted.bmj.com/rosaceabeyondthevisible

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