Differential diagnosis

• acne occurs in younger patients and is characterized by comedones. It does not feature erythema, telangiectasia or flushing
• light sensitivity and contact dermatitis develop more quickly and lack pustules " chronic discoid lupus erythematosus has discrete scaly lesions. The rash of systemic lupus erythematosus is more rapid in onset
• acne rosacea
• perioral dermatitis patients have micropustules and microvesicles around the mouth or eyes and dry, sensitive skin may result from the inappropriate use of topical corticosteroids
• seborrhoeic dermatitis may sometimes accompany rosacea and contribute to facial erythema, but a prominence of yellowish scaling around the eyebrows and alae nasi, together with troublesome dandruff helps in differentiating it from rosacea
• atypical or nodular rhinophyma needs to be differentiated from lupus pernio (sarcoidosis of the nose); basal cell, squamous cell, and sebaceous carcinomas; angiosarcoma; and nasal lymphoma. Sometimes a biopsy maybe required for the diagnosis.

Reference:

1. Johnson SM et al. Recognizing Rosacea: Tips on Differential Diagnosis. J Drugs Dermatol. 2019 Sep 1;18(9):888-894.