Facial redness is the primary diagnostic sign of rosacea. In fact, persistent redness alone on the central part of the face—the nose, cheeks, or chin—may be enough for a dermatologist to diagnose the condition.
Rosacea often begins as flushing or facial redness that comes and goes. Without treatment, it may become ruddier and more persistent, often triggered by environmental or lifestyle factors that exacerbate the condition. Over time, bumps and pimples may also develop, and in severe cases the skin on the nose may thicken and appear swollen from excess tissue. In many patients, the eyes are also affected (ocular rosacea), with feelings of irritation, stinging, or burning and the eyes may appear bloodshot.
Persistent facial erythema associated with rosacea may negatively impact quality of life (QoL), self-esteem, and self-confidence.1 Blushing and flushing have been reported by patients to be the most bothersome symptoms of rosacea, regardless of disease severity.2 Additionally, patients’ satisfaction with their facial appearance significantly decreased, and worry about others’ reactions and feelings of unattractiveness to others significantly increased, with greater erythema severity.2
To help rosacea sufferers assess facial redness, the National Rosacea Society (NRS) has introduced a new patient booklet called “Recognizing Redness.” The purpose of the tool is to help patients determine whether they should see a dermatologist for evaluation and appropriate care of their symptoms, as well as to monitor the progress of therapy for those being treated for rosacea. Previous studies have validated patient self-assessments of erythema severity as being reliable in patients with rosacea.3
The booklet includes a redness register (Figure) to allow patients to gauge relative redness before and after flare-ups or treatment. The redness register is a scale with nine shades of redness, from very light to dark red. In a well-lit room with a mirror, the patient holds the color scale to the back of their hand, neck, or other area of skin that gets as much sun exposure as their face and determines the shade of redness that appears to represent the closest match for the redness in their skin, disregarding skin tone, and records the number. Next, the patient looks in the mirror and holds the redness register to their face where affected, determines the shade that most closely matches the redness, and records the number. A difference of two or more shades may indicate rosacea, and greater difference may indicate greater severity.
Figure. Redness register, with a scale from 1 (very light) to 9 (dark red). To use, the patient holds the color scale to an area of skin that gets as much sun exposure as their face and records the number of the shade of redness that appears to represent the closest match for the redness in their skin. Then, the patient holds the redness register to their face where affected, determines the shade that most closely matches that redness, and records the number. A difference of two or more shades may indicate rosacea.
Along with facial redness, dermatologists can make a diagnosis of rosacea based on other common signs and symptoms. The diagnosis of rosacea is often first made in individuals aged 30 to 60 years. Women are two to three times more likely to be affected than men; however, men may be more likely to have severe symptoms and phymatous overgrowth of skin (especially rhinophyma). Rosacea is also most common in fair-skinned individuals with Northern European heritage, but it can affect all ethnicities and skin types.4Some studies have suggested that rosacea is underreported in people with skin of color.5
The tool may also be used to track improvement in facial redness under medical therapy.
“The new Recognizing Redness booklet is an excellent tool for patients to understand the disorder and assess the fluctuations in their complexion,” said Estee Williams, MD, assistant clinical professor of dermatology at Mount Sinai Medical Center in New York, NY, in a press release from the NRS. “Because rosacea redness is so variable and can be difficult to measure by eye, it is useful to be able to objectively track improvement made by medical therapy and avoidance of triggers for flare-ups.”
In addition to the redness register, the booklet includes information about rosacea and how it is diagnosed, as well as a list of the most common rosacea triggers.
The new “Recognizing Redness” booklet may be downloaded free of charge on the NRS website. It can also be obtained by writing the NRS at 196 James Street, Barrington, IL 60010; calling the Society at 888-NO-BLUSH; or emailing firstname.lastname@example.org. Health professionals may also order bulk quantities for use as handouts to patients with rosacea. The new booklet was made possible by support from Aclaris Therapeutics, Inc.
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 [published online September 11, 2019]. Dermatol Ther (Heidelb). doi:10.1007/s13555-019-00322-5
2. Harper J, Del Rosso JQ, Ferrusi IL. Cross-sectional survey of the burden of illness of rosacea by erythema severity. J Drugs Dermatol. 2018;17(2):150–158.
3. Tan J, Leoni M. Erythema of rosacea: validation of patient’s self-assessment grading scale. J Drugs Dermatol. 2015;14(8):841–844.
4. Johnson SM, Berg A, Barr C. Recognizing rosacea: tips on differential diagnosis. J Drugs Dermatol. 2019;18(9):888–894.
5. Cices A, Alexis AF. Patient-focused solutions in rosacea management: treatment challenges in special patient groups. J Drugs Dermatol. 2019;18(7):608–612.