Diagnostic Quiz: Persistent Redness & Inflammatory Flares

NEWS/ QUIZ

2 MIN QUIZ

A 30-year-old woman makes an appointment to see a dermatologist for the first time. The patient is worried about a persistent redness on her nose and upper and lower cheeks that will not go away. At first, the patient thought the redness was related to repeated exposure to the sun, but the redness has lingered and worsened even after using sunscreen and trying a variety of over-the-counter lotions. After asking about the patient’s history, the dermatologist has learned that in the past, the patient had experienced flares of what she thought was mild acne with some inflammatory papules and pustules and accompanying erythema, but she has not had a flare for a few years and thought she was past the condition.

Based on this history, what is the correct diagnosis?

Select the correct answer

A) Chronic sun damage

B) Perioral erythema

C) Generalized rash

D) Rosacea

E) Systemic lupus erythematosus (SLE)

CORRECT

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INCORRECT

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Answer is: D

Persistent facial redness is one of the most common and bothersome symptoms of rosacea, and often, it is the only visible sign of disease.^1,2 In contrast to perilesional erythema that accompanies the papulopustular lesions associated with rosacea, diffuse and transient and persistent facial erythema, also known as “background erythema,” is a primary feature in most clinical presentations of rosacea.²

Transient erythema is often a precursory feature of rosacea that can begin in childhood and early adulthood, long before a diagnosis, and persists between flares of rosacea that present with other visible symptoms.Aside from the invisible symptoms of burning and stinging, transient erythema is the only sign experienced by 100% of rosacea patients across all stages and subtypes of the disease.^4,5

Studies have shown that rosacea-related facial erythema has a significant impact on a patient’s self-esteem that impacts a patient’s daily life; and, without treatment, can cause life-long emotional suffering.^1,6,7 Early diagnosis and consistent treatment of rosacea is the key to managing transient erythema and may help stop the progression of the disease, which can cause structural vascular changes and permanent dilation of blood vessels on the central face and nose.^2,8

Although facial erythema can be a symptom of many different dermatological conditions, since 2016, a global consensus panel of rosacea experts (ROSCO) has recommended that “persistent centrofacial redness associated with periodic intensification by potential trigger factors” could be considered an independent diagnostic criterion for rosacea.^3,9

As always, patients should consult with their dermatologist before treating the signs of erythema, but thankfully with new understanding of the mechanisms of transient erythema and rosacea, there are more approved treatment options that can serve the individual needs of the patient.^2,10

References:

1. Baldwin HE, Harper J, Baradaran S, Patel V. Erythema of rosacea affects health-related quality of life: results of a survey conducted in collaboration with the National Rosacea Society. Dermatol Ther (Heidelb). 2019;9(4):725-734. doi:10.1007/s13555-019-00322-5

2. Del Rosso JQ. Advances in understanding and managing rosacea: part 2: the central role, evaluation, and medical management of diffuse and persistent facial erythema of rosacea. J Clin Aesthet Dermatol. 2012;5(3):26-36.

3. Schaller M, Almeida LMC, 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, 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

5. Scharschmidt TC, Yost JM, Truong SV, Steinhoff M, Wang KC, Berger TG. Neurogenic rosacea: a distinct clinical subtype requiring a modified approach to treatment. Arch Dermatol. 2011;147(1):123-126. doi:10.1001/archdermatol.2010.413

6. Huynh TT. Burden of disease: the psychosocial impact of rosacea on a patient's quality of life. Am Health Drug Benefits. 2013;6(6):348-354.

7. Dirschka T, Micali G, Papadopoulos L, Tan J, Layton A, Moore S. Perceptions on the psychological impact of facial erythema associated with rosacea: results of international survey. Dermatol Ther (Heidelb). 2015;5(2):117-127. doi:10.1007/s13555-015-0077-2

8. Cohen AF, Tiemstra JD. Diagnosis and treatment of rosacea. J Am Board Fam Pract. 2002;15(3):214-217.

9. Gallo RL, Baldwin H, Gold LS, Harper J. Update on facial erythema in rosacea. J Drugs Dermatol. 2021;20(8):861-864. doi:10.36849/JDD.6062

10. Thiboutot D, Anderson R, Cook-Bolden F, et al. Standard management options for rosacea: the 2019 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. 2020;82(6):1501-1510. doi:10.1016/j.jaad.2020.01.077

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