Who’s Diagnosing Rosacea: Dermatologists or Nondermatologists?

A family physician was the first to notice possible signs of rosacea in approximately one-quarter of rosacea patients, according to a recent survey from the National Rosacea Society (NRS). Other health care professionals making the initial observation included ophthalmologists, internists, optometrists, nurse practitioners, physician assistants, allergists, gynecologists, and dentists. However, dermatologists made the definitive diagnosis of rosacea in the majority of cases (85%).

The spring 2015 edition of Rosacea Review, the NRS newsletter, reported on the results of a survey of 774 rosacea patients. Other health care professionals who diagnosed rosacea included family physicians (9%), ophthalmologists (4%), and internists and allergists (1% each).

Survey results from NRS also indicated that dermatologists were the most likely to provide ongoing care to rosacea patients. In fact, 80% of respondents said they were under the care of a dermatologist, while 24% received treatment from a family physician, 10% from an ophthalmologist, 3% from an internist, and 0.5% from an allergist. Many patients indicated that they received care from more than one physician.

A December 2014 Cutis article “Most Common Dermatologic Conditions Encountered by Dermatologists and Nondermatologists” also indicated that nondermatologists are seeing patients for skin conditions. Wilmer et al analyzed data from the National Ambulatory Medical Care Survey and reported that rosacea ranked ninth in the top dermatologic conditions seen by dermatologists. Although rosacea did not rank in the top 20 dermatologic conditions seen by nondermatologists, it did rank 10th in the top referrals to dermatologists by nondermatologists. Of nondermatologist specialties evaluated, including emergency medicine, family practice, general surgery, internal medicine, otolaryngology, and pediatrics, rosacea was within the top 20 dermatologic conditions encountered by otolaryngologists only. These findings suggest that nondermatologists may benefit from education efforts targeted toward the common skin diseases to improve diagnostic accuracy and patient outcomes.

A January 2015 Cutis article “The Rosacea Patient Journey: A Novel Approach to Conceptualizing Patient Experiences” revealed that rosacea patients may seek care of a health care professional after experiencing persistent facial flushing, an intolerable burning sensation, or too much pain and embarrassment associated with their symptoms. Ultimately patients should seek the care of a dermatologist to ensure their condition is not misdiagnosed. However, issues of access to dermatologic care and receiving the correct diagnosis come into play, as patients may experience long wait times for appointments with a dermatologist.

“When we think of the rosacea journey or ways we can improve the journey, coming up with ways to facilitate patient’s access to dermatologists would be something that would come to mind, not just changing the available medications,” said Dr. Steven Feldman, one of the authors of the rosacea patient journey article, in a recent audiocast. “I think it’s likely that many of the people with rosacea are being seen by primary care doctors but their rosacea may never even come up in their discussions.”

Improved awareness of the signs and symptoms of rosacea among health care professionals is beneficial to patients, and dermatologists can be leaders in expanding education efforts.