Dermoscopic spectrum of rosacea

Abstract

AbstractBackgroundRosacea is a chronic inflammatory disease that manifests with various signs and symptoms including erythema, telangiectasias, papules and pustules that mostly affect cheeks, chin, nose and the central forehead. Rosacea is considered as a continuous spectrum that includes different subtypes/phenotypes (erythematotelangiectatic, papulopustular, phymatous), and might also encompass lupus miliaris disseminatus faciei (LMDF) and roasecea‐like demodicosis.ObjectiveTo assess the dermoscopic features of the different rosacea subtypes/phenotypes.MethodsPatients with a clinical diagnosis of rosacea, confirmed or not by histopathology, or rosacea‐like demodicosis diagnosed by skin scrapings or LMDF diagnosed histopathologically were included. Dermoscopic images were evaluated for the presence of predefined criteria. The selection of dermoscopic variables was based on the International Dermoscopy Society Consensus on standardisation of terminology.ResultsEighty‐five patients with facial lesions of rosacea were included in the analysis. Linear reticular vessels in regular distribution were present in the vast majority of the erythematotelangiectatic subtype forming the characteristic pattern of vascular polygons. A similar, but less pronounced, vascular pattern was typified in papulopustular subtype, with the additional presence of follicular plugs and pustules. Phymatous rosacea was characterised by variable morphologic types of vessels in a reticular arrangement, combined with follicular yellow clods. In granulomatous rosacea, focal orange structureless areas were found in all cases and perifollicular orange colour in most of them. In dermoscopy of LMDF, follicular criteria predominated, with perifollicular orange colour and follicular plugs being present in all cases. In demodicosis, the prevailing dermoscopic finding was white mass protruding out of the hair follicle.ConclusionThis study suggests that dermoscopy facilitates the recognition of the clinical subtypes/phenotypes of rosacea, enhancing the clinical diagnosis and prompt therapeutic choices.