A 45-year-old woman presents with a 2-year history of persistent facial flushing and visible redness over the cheeks, nose, and chin. She reports that her symptoms worsen with hot beverages, spicy foods, and sun exposure. On examination, the structure marked **A** in the diagram is noted, along with visible dilated surface vessels. There are no comedones present. Which of the following is the most likely diagnosis?

Explanation

## Why "Rosacea, erythematotelangiectatic subtype" is right The clinical presentation of persistent central facial erythema (marked **A**) in a 45-year-old woman, combined with telangiectasias, flushing triggered by heat and spicy foods, and the ABSENCE of comedones, is pathognomonic for rosacea. The erythematotelangiectatic subtype is characterized by exactly this triad: persistent erythema + visible telangiectasias + transient flushing. The central distribution (cheeks, nose, chin, forehead) and age of onset (30–60 years) further support this diagnosis. Per Robbins 10e Ch 25 and Harrison 21e Ch 56, rosacea is a chronic inflammatory condition distinguished from acne by the absence of comedones, the characteristic flushing and telangiectasias, and the typical age group. ## Why each distractor is wrong - **Acne vulgaris with post-inflammatory erythema**: Acne is predominantly a disease of adolescents and young adults, not 45-year-olds. Critically, acne presents with comedones (blackheads and whiteheads), which are absent in this patient. Acne does not feature the transient flushing or prominent telangiectasias seen in rosacea. - **Seborrheic dermatitis with secondary vasodilation**: Seborrheic dermatitis presents with greasy, scaly plaques (often on scalp, eyebrows, nasolabial folds) and is not characterized by the persistent central facial erythema or flushing pattern described. The trigger history (heat, spicy foods) is not typical of seborrheic dermatitis. - **Lupus erythematosus (cutaneous form)**: While lupus can present with facial erythema (malar rash), it typically spares the nasolabial folds (unlike rosacea which affects the central face including the nose). Lupus erythema is usually photosensitive but not triggered by spicy foods or hot beverages. Systemic features and serologic abnormalities would be expected. **High-Yield:** Rosacea = persistent central facial erythema + telangiectasias + flushing + NO comedones + age 30–60; acne = comedones + adolescent/young adult + no flushing/telangiectasias. [cite: Robbins 10e Ch 25; Harrison 21e Ch 56]