The psychosocial impact of rosacea and negative effects on emotional health and quality of life are often under-appreciated by clinicians.10 The signs of rosacea (redness, telangiectasias) can be interpreted by lay persons as signs of excessive alcohol consumption, leading to stigmatization that exacerbates emotional distress.10
The Diverse Sources of Redness in Rosacea
Rosacea is characterized by redness, but it is very important – particularly in designing management strategies – for the clinician to be aware that there are differing sources of skin redness.11,16 Identifying the redness source will help target treatment options and patient education. Figure 3 illustrates how a patient may have various causes of facial erythema—they may have persistent erythema without a lesional aspect, erythema plus inflammatory lesions, perilesional erythema, or redness due to permanent blood vessel dilation and neoangiogenesis. Transient erythema may also occur. These different sources of redness require different treatments, and patients should be educated about what to expect with a specific treatment. For example, a treatment that targets lesions may have little to no effect on persistent erythema or telangiectasias. On the other hand, a treatment that targets only diffuse erythema may give the perception that the lesions have become worse or more red, when simply the camouflage of the background redness has disappeared making the lesions stand out more.
Trigger Factors in Rosacea
Patients with rosacea often indicate that certain factors trigger exacerbations; Table 1 presents the most common rosacea triggers according to a recent survey by the National Rosacea Society.17 It can be useful for patients to keep a diary to identify triggers that should be avoided; diaries are available at www. rosacea.org.6
Step 2 in Recognizing Rosacea: Differential Diagnosis
Distinguishing between rosacea and other conditions can be challenging, particularly since the specific facial and ocular