Rosacea
Rosacea is a chronic inflammatory facial skin disorder with recurrent flushing that produces persistent central-face erythema, telangiectasias, and papulopustules without comedones, triggered by heat, sun, alcohol, and spicy food. Diagnosis is clinical based on subtype; treatment is matched to subtype, with topical metronidazole, azelaic acid, or ivermectin and oral doxycycline for papulopustular disease, laser therapy for telangiectasias, and laser or surgery for rhinophyma.
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What this article covers
- Overview
Definition: rosacea is a chronic inflammatory dermatosis of the central face marked by recurrent flushing that leaves behind persistent erythema, telangiectasias, and, in some patients, inflammatory papules and pustules.
- Epidemiology
Typical patient: rosacea classically affects middle-aged adults with fair skin.
- Risk factors
Fair skin type: patients with lighter skin pigmentation are disproportionately affected.
- Pathophysiology
Vascular basis of erythema: repeated flushing episodes leave the central-face vessels dilated, and with repeated cycles the dilation becomes fixed as visible telangiectasias and persistent erythema.
- Clinical features
Erythrotelangiectatic rosacea: persistent central-face erythema and telangiectasias on sensitive skin, which may or may not involve the nasolabial folds, with flushing precipitated by stress, alcohol, heat, sunlight, and spicy foods.
- Differential diagnosis
Acne vulgaris: presents with papules and pustules on the face, chest, and back, but is defined by open and closed comedones, which are absent in rosacea.
- Diagnosis
Diagnostic basis: rosacea is a clinical diagnosis established by identifying the subtype-defining pattern (persistent central erythema with telangiectasias, papulopustules without comedones…
- Management
First step for every subtype: counsel on trigger avoidance (heat, alcohol, hot beverages, spicy food, sun) and photoprotection, plus gentle, non-irritating skin care, since these measures reduce flushing frequency regardless of subtype.
- Complications
Rhinophyma: untreated phymatous rosacea can progress to permanent bulbous nasal deformity from sebaceous and connective-tissue overgrowth, which requires laser or surgical correction rather than resolving with medical therapy.
- Prognosis
Chronic but controllable: rosacea is a long-term condition, but trigger avoidance combined with subtype-matched therapy controls most patients' erythema and papulopustules.
- Prevention
Identify and avoid individual triggers: heat, sunlight, alcohol, hot beverages, and spicy food are the most consistently reported triggers and should be systematically reviewed with each patient.
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