Erythematous, violaceous, or hyperpigmented patches may present with telangiectasias on the cheeks and glabella. In darker skin tones acneiform papules amidst mild phymatous changes (pronounced and dilated ostia) may be a better diagnostic clue. It is important not to be limited by the guideline based essential feature of persistent erythema.

One of the early signs of rosacea is flushing, which can be easily missed or even mistaken in darker skin tones for another condition. However, often all patients describe a feeling of warmth.

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