To confirm or rule out SLE, Taylor et al. suggest performing a complete physical examination and a skin biopsy with hematoxylin and eosin and direct immunofluorescence, as well as checking serologies including antinuclear antibody (ANA).
Although elevated ANA has been reported in patients with rosacea, it is lower than what is typically seen in SLE. If ANA is elevated, Dr. Taylor advises checking more specific SLE antibodies; for example, the double-stranded DNA test is positive in lupus. SLE also can be differentiated histologically by a considerably lower CD4:CD8 ratio, fewer CD4+CD25+ regulatory T cells and more CD123+ plasmocytoid dendritic cells versus rosacea.
Rosacea and seborrheic dermatitis can present concurrently. Symptoms of seborrheic dermatitis include erythematous patches and plaques involving the scalp, anterior and posterior hairlines, pre- and post-auricular areas and medial eyebrows. Both rosacea and seborrheic dermatitis may impact the nasolabial folds, but the presence of scale distinguishes the latter.
Additionally, the erythematous lesions of seborrheic dermatitis are often annular, and the postinflammatory hypopigmentation (and to a lesser extent, hyperpigmentation) common to this condition are relatively uncommon in rosacea.
The heliotrope rash that marks dermatomyositis differs from rosacea in its dusky, violaceous hue and its periorbital involvement. Other signs that indicate dermatomyositis, which is four times more common in African-American versus Caucasian patients, include edema of the face and extremities, Gottron papules and poikiloderma.
Dr. Taylor has been an investigator, speaker and advisory board member for Aclaris (maker ofoxymetazoline) and an advisory board member for Galderma (maker of brimonidine).
1. Onalaja AA, Lester JC, Taylor SC. Establishing the diagnosis of rosacea in skin of color patients. Cutis. 2019;104:38-41.
2. Alexis AF. Rosacea in patients with skin of color: uncommon but not rare. Cutis. 2010;86:60-62.
3. Dlova NC, Mosam A. Rosacea in black South Africans with skin phototypes V and VI. Clin Exp Dermatol. 2017;42:670-673.