the four faces of rosacea

Understanding rosacea is a continuous process.  Only within the last several years has rosacea been classified into four subtypes, and research brings us more information all the time. Only a physician can make a diagnosis, but it is important for the skin care clinician to be able to recognize these various presentations in order to educate the patient and make an appropriate recommendation to a physician. 

Rosacea cannot be cured only controlled, so it is important for the rosacea patient to understand what triggers this condition.  Heat, spicy foods, hot showers or hot tubs, certain types of cosmetics or extremes in temperature are some of the triggers that should be avoided.

Subtype one – erythematotelangiectatic rosacea is characterized by persistent redness within the central portion of the face, with possible telangiectasias (visible capillaries). The patient will become red or flushed easier and stay red longer.

Subtype 2 – papulopustular rosacea is characterized by persistent redness in the same area, including lesions that resemble papules and pustules.  This subtype is commonly referred to as acne rosacea because of its presentation, but absolutely cannot be treated in the same manner as acne.  One way to differentiate this presentation from acne is that the lesions will appear only within the inflamed area.  Blackheads and cysts will not typically be present.

Subtype three – phymatous rosacea is characterized by a thickening of the skin, most commonly seen on the nose (rhinophyma) but can affect other areas of the face such as the glabella and chin. This type of rosacea presents mostly in men and can be treated surgically.

Subtype four – ocular rosacea affects the eye area, and includes symptoms such as eye irritation, conjunctivitis (pink eye), blepharitis (inflammation of the eyelids), frequent styes, itching, burning and stinging of the eyes.  This type of rosacea is often misdiagnosed, and if left untreated, can lead to blindness.

Patients can have subtype one and subtype four rosacea, or subtype two and three.  This condition doesn’t necessarily progress from one subtype to the next.

Many people have rosacea and don’t even know it.  For more information, go to


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