What rosacea looks like and how it is diagnosed

Rosacea usually looks like redness across the nose and cheeks that stays for weeks or longer. Many people also have small red bumps, bumps with pus, or thin visible blood vessels. On darker skin, the color can look violet or brown, and the first signs may be a warm feeling or bumps. Rosacea can look like several other conditions, so only a doctor can confirm it. The American Academy of Dermatology (AAD) recommends a board-certified dermatologist for this. There is no lab test for rosacea. A doctor diagnoses it by examining your skin and eyes and asking about your history.

This guide covers what rosacea looks like at each stage, the questions that point to it, how a doctor makes the diagnosis, and how to prepare for the visit. For the full overview, start with what rosacea is.

Where rosacea shows on the face

The AAD says rosacea develops on the face, usually across the nose and cheeks. It calls a permanently red face in the center of the face (nose, cheeks, forehead and chin) the most common sign. Less often, it spreads to the ears, scalp, neck, upper chest or back.

The main signs a doctor looks for:

• Lasting color. Red or pink on lighter skin. Violet or brown on darker skin. It stays for weeks, months or longer.
• Flushing. Redness and warmth that come and go, and last longer over time.
• Bumps. Small red bumps and bumps with pus that look like acne.
• Visible blood vessels. Thin red lines on the cheeks and nose, easy to see on lighter skin and hard to see on darker skin.
• Swelling. Most often around the eyes, on the forehead or on the cheeks.
• Dry, rough skin. Scaly patches that may burn or sting.
• Eye signs. Red, swollen eyelids, and eyes that feel gritty or dry.
• Thickened skin. Less common, mostly on the nose, and more common in men.

The AAD says it is common to have more than one sign, and most people have some of them and not all. The guide to rosacea symptoms goes through each sign in detail.

How rosacea looks on darker skin

The AAD says early rosacea on darker skin is often missed or mistaken for another condition. The NHS says redness can be harder to see on brown or black skin. NIAMS, the skin institute of the US National Institutes of Health (NIH), says darker skin can hide facial redness, so rosacea may be under-diagnosed.

The AAD lists signs to watch for on darker skin: a warm feeling most of the time, dry and swollen skin with patches of darker skin, a dusky brown color, acne-like bumps that acne treatment does not clear, yellowish-brown hard bumps around the mouth or eyes, burning or stinging from skin care products, and swelling or thickening on the nose, cheeks, chin or forehead.

Mild and severe rosacea

Rosacea often changes over time. NIAMS describes a common path: first short flushing of the nose and cheeks, then flushing that lasts longer, then a rash and small blood vessels. Without treatment, the skin may thicken, with firm red bumps, most often on the nose.

Mild rosacea usually looks like flushing that comes and goes, or light redness across the nose and cheeks. The NHS says early redness usually lasts a few minutes each time. The face may feel warm, hot or painful.

More severe rosacea can include redness that never fades, many bumps, visible blood vessels, swelling and thicker skin. NIAMS says a thickened nose can look enlarged and bulb-shaped, and that this mostly affects men. The AAD says the more rosacea progresses, the harder it is to treat. The AAD also says the earlier treatment starts, the easier rosacea is to manage, which is a reason to see a doctor while signs are still mild.

Flushing or rosacea?

Everyone flushes. The AAD says people flush when they feel embarrassed, get too hot, drink alcohol or spend time outside on a cold or windy day. Normal flushing like this clears within a few hours or less.

With rosacea, the AAD says the redness or violet color lasts longer, and becomes more noticeable when something triggers it. Rosacea often begins with a tendency to flush. If you flush more often than before, or the color and warmth last longer and longer, the AAD says you might have rosacea.

Questions that point to rosacea

The AAD suggests asking yourself:

• Do you have acne-like bumps that nothing seems to clear?
• Are you bothered by frequent sunburns on your face?
• Does your face often feel warm?
• Does your skin sting or burn when you apply certain skin care products?

If you answer yes, the AAD says you might have rosacea, and it recommends seeing a board-certified dermatologist to find out what is causing your skin condition.

How a doctor diagnoses rosacea

The AAD says a dermatologist diagnoses rosacea by examining your skin and eyes. Because rosacea signs come and go, the dermatologist will also ask you questions. NIAMS says there is no specific test for rosacea, so doctors base the diagnosis on how your skin and eyes look and on your medical history.

Tests are sometimes needed to rule out other conditions. The AAD says testing may be needed to rule out lupus, which can also cause a long-lasting color change on the face. If the doctor suspects a rare type called granulomatous rosacea, a skin biopsy may be needed. A biopsy means the doctor removes a small piece of skin during an office visit, while you stay awake, and a lab looks at it under a microscope.

The NHS says to see a GP, a family doctor, if you have symptoms of rosacea. A GP may refer you to a dermatologist if treatment does not work. If your eyes are affected, NIAMS says an eye doctor may be involved too.

Conditions that can look like rosacea

The NHS lists these conditions that can look like rosacea:

Condition	In plain words
Acne	Blocked pores that cause pimples, blackheads and whiteheads
Contact dermatitis	A rash caused by something that touches the skin
Seborrhoeic dermatitis	A red rash with flaky scales
Lupus	A disease that can also cause long-lasting color on the face, per the AAD
Keratosis pilaris	Small, rough bumps on the skin

The AAD adds rosy cheeks, sunburn, eczema and allergic skin reactions. For the most common mix-up, see the guide to rosacea vs acne.

Rosacea in children

The AAD says few children and teens get rosacea. It suggests considering rosacea if a child often has red, irritated eyes, styes or pinkeye, red and swollen eyelids, or flushing that lasts. In children, the eye signs are often the ones that show, and the AAD says ocular rosacea is often missed in children.

To diagnose rosacea in a child, the AAD says a dermatologist examines the face and eyes and rules out more common childhood conditions that look like it, including acne, skin infections and allergic skin reactions. A blood test may be needed. The dermatologist may ask whether close relatives have rosacea, whether the child has other medical conditions, and which medicines the child has used. The AAD says the child's skin or eyes may be clear on the day of the visit, and that the appointment is still worth keeping.

How to prepare for your appointment

Rosacea signs come and go, so your face may look clear on the day of the visit. A few steps can help your doctor see how your skin changes:

• Take photos of your face on days when the redness or bumps are at their worst.
• Keep a short diary of when you flush and what came before it. The AAD suggests recording food, drinks, products and weather for at least 2 weeks to find triggers. The guide to rosacea triggers shows how.
• List every skin and hair product you use.
• List your medicines. The AAD says some medicines can make rosacea worse, so your doctor needs to know what you take.
• Mention any eye symptoms, even if they seem minor. The AAD says rosacea can affect the eyes before the skin.
• Say whether a blood relative has rosacea or severe acne. The AAD lists this as a risk factor.

After the diagnosis

If a doctor confirms rosacea, the AAD says the treatment plan will be built around your signs. It usually includes finding and avoiding your triggers, gentle skin care, daily sunscreen, and medicine or a procedure when needed. The guide to how rosacea is treated explains what a doctor may offer.