Rosacea Workup

  • Author: Agnieszka Kupiec Banasikowska, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: May 31, 2011
 

Laboratory Studies

The diagnosis is made clinically.

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Procedures

A skin biopsy is sometimes performed to exclude other cutaneous diseases, such as lupus or sarcoidosis.

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Histologic Findings

The histologic features of rosacea depend on the stage of disease. Nonpustular lesions show a nonspecific perivascular and perifollicular lymphohistiocytic infiltrate, accompanied by occasional multinucleated cells, plasma cells, neutrophils, and eosinophils. Papulopustular lesions demonstrate more pronounced granulomatous inflammation and sometimes perifollicular abscesses. Demodex folliculorum may be abundant in nearby follicles. The histologic features of acne agminata are striking, demonstrating caseating granulomata with negative stains for mycobacteria and fungi. See the images below.

Histopathology of rosacea. Perifollicular chronic Histopathology of rosacea. Perifollicular chronic inflammation and vascular ectasia. Courtesy of Dirk Elston, MD. Caseating granuloma in lupus miliaris disseminatusCaseating granuloma in lupus miliaris disseminatus faciei. Courtesy of Dirk Elston, MD.
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Contributor Information and Disclosures
Author

Agnieszka Kupiec Banasikowska, MD  Consulting Staff, Georgetown Dermatology, PLLC

Agnieszka Kupiec Banasikowska, MD is a member of the following medical societies: American Academy of Dermatology and European Academy of Dermatology and Venereology

Disclosure: Nothing to disclose.

Coauthor(s)

Saurabh Singh, MD  Staff Physician, Department of Dermatology, Georgetown University/Washington Hospital Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Franklin Flowers, MD  Chief, Division of Dermatology, Professor, Department of Medicine and Otolaryngology, Affiliate Associate Professor of Pediatrics and Pathology, University of Florida College of Medicine

Franklin Flowers, MD, is a member of the following medical societies: American College of Mohs Micrographic Surgery and Cutaneous Oncology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Christen M Mowad, MD  Associate Professor, Department of Dermatology, Geisinger Medical Center

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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  2. Crawford GH, Pelle MT, James WD. Rosacea: I. Etiology, pathogenesis, and subtype classification. J Am Acad Dermatol. Sep 2004;51(3):327-41; quiz 342-4. [Medline].

  3. Dahl MV. Rosacea subtypes: a treatment algorithm. Cutis. Sep 2004;74(3 Suppl):21-7, 32-4. [Medline].

  4. Laquer V, Hoang V, Nguyen A, Kelly KM. Angiogenesis in cutaneous disease: part II. J Am Acad Dermatol. Dec 2009;61(6):945-58; quiz 959-60. [Medline].

  5. Bonnar E, Eustace P, Powell FC. The Demodex mite population in rosacea. J Am Acad Dermatol. Mar 1993;28(3):443-8. [Medline].

  6. Tisma VS, Basta-Juzbasic A, Jaganjac M, et al. Oxidative stress and ferritin expression in the skin of patients with rosacea. J Am Acad Dermatol. Feb 2009;60(2):270-6. [Medline].

  7. Jones DA. Rosacea, reactive oxygen species, and azelaic acid. J Clin Aesthetic Derm. Jan 2009;2(1):26-30.

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  9. Schauber J, Gallo RL. Antimicrobial peptides and the skin immune defense system. J Allergy Clin Immunol. Aug 2008;122(2):261-6. [Medline].

  10. Aloi F, Tomasini C, Soro E, Pippione M. The clinicopathologic spectrum of rhinophyma. J Am Acad Dermatol. Mar 2000;42(3):468-72. [Medline].

  11. Greaves MW, Burova E. Flushing: causes, investigation and clinical consequences. J Eur Acad Dermatol Venereol. 1997;8:91-100.

  12. Higgins E, du Vivier A. Alcohol intake and other skin disorders. Clin Dermatol. Jul-Aug 1999;17(4):437-41. [Medline].

  13. Powell FC. Clinical practice. Rosacea. N Engl J Med. Feb 24 2005;352(8):793-803. [Medline].

  14. Lonne-Rahm S, Nordlind K, Edstrom DW, Ros AM, Berg M. Laser treatment of rosacea: a pathoetiological study. Arch Dermatol. Nov 2004;140(11):1345-9. [Medline].

  15. Ceilley RI. Advances in the topical treatment of acne and rosacea. J Drugs Dermatol. Sep-Oct 2004;3(5 Suppl):S12-22. [Medline].

  16. Ertl GA, Levine N, Kligman AM. A comparison of the efficacy of topical tretinoin and low-dose oral isotretinoin in rosacea. Arch Dermatol. Mar 1994;130(3):319-24. [Medline].

  17. Gupta AK, Chaudhry MM. Rosacea and its management: an overview. J Eur Acad Dermatol Venereol. May 2005;19(3):273-85. [Medline].

  18. Baldwin HE. Systemic therapy for rosacea. Skin Therapy Lett. Mar 2007;12(2):1-5, 9. [Medline].

  19. Chu CY. The use of 1% pimecrolimus cream for the treatment of steroid-induced rosacea. Br J Dermatol. Feb 2005;152(2):396-9. [Medline].

  20. van Zuuren EJ, Kramer S, Carter B, Graber MA, Fedorowicz Z. Interventions for rosacea. Cochrane Database Syst Rev. Mar 16 2011;3:CD003262. [Medline].

 
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Acne rosacea. Courtesy of Dirk Elston, MD.
Pustular rosacea. Courtesy of Dirk Elston, MD.
Histopathology of rosacea. Perifollicular chronic inflammation and vascular ectasia. Courtesy of Dirk Elston, MD.
Lupus miliaris disseminatus faciei. Courtesy of Dirk Elston, MD.
Caseating granuloma in lupus miliaris disseminatus faciei. Courtesy of Dirk Elston, MD.
 
 
 
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