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When to refer to a dermatologist It is reasonable to consider referral of a patient with rosacea to a dermatologist for the following presentations: disease that worsens or does not respond to treatment over a six- to 12-week trial interval severe disease with phymatous change at presentation disease that severely impacts quality of life, as this may require a combination of treatment options and aggressive early treatment coexisting multiple phenotypic clinical presentations, which may necessitate concurrent combination treatment
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