Types of rosacea explained

Share on Pinterest

Rosacea has four subtypes. These are:

• erythematotelangiectatic rosacea
• papulopustular rosacea
• phymatous rosacea
• ocular rosacea

What is rosacea?

Rosacea is the result of inflammation and irritation of the blood vessels and the pilosebaceous units of the face. It has several triggers ranging from sensitivity to topical skin applications, alcohol and food consumption, emotional responses, and more.

Rosacea is common, affecting around 1–20% of the population.

Erythematotelangiectatic rosacea is the most common subtype of rosacea. It involves persistent redness of the center of the face. The small blood vessels beneath the skin’s surface become enlarged and visible.

People with erythematotelangiectatic rosacea may also experience a burning sensation and skin sensitivity. It commonly occurs in conjunction with papulopustular rosacea.

Symptoms

Symptoms of erythematotelangiectatic rosacea include:

• flushing
• redness or discoloration of the center of the face
• occasional flushing of the ears, neck, and chest
• visible blood vessels
• flare-ups that usually disappear later but can become permanent
• sensitivity
• burning or stinging

Treatment

Erythematotelangiectatic rosacea can respond poorly to treatment. However, recent research into new treatments, such as tranexamic acid, shows promising advancements.

Health professionals may also recommend that people avoid triggers, such as alcohol, stress, or high sun exposure, and develop a skin care routine using a gentle cleanser.

Other topical and physical modality treatments for erythematotelangiectatic rosacea include:

• metronidazole
• azelaic acid
• brimonidine
• laser therapies

Papulopustular rosacea, which often occurs alongside erythematotelangiectatic rosacea, is associated with pus-filled pimples and swollen red bumps on the face. It may also affect the scalp, neck, and chest. People commonly mistake it for acne. These blemishes can take a long time to go away.

Symptoms

Symptoms of papulopustular rosacea include:

• papules or pustules on the forehead, cheeks, and chin
• swollen red bumps that take a long time to disappear
• flushing
• small visible blood vessels
• raised, scaly red patches of skin

Treatment

As with erythematotelangiectatic rosacea, doctors will usually encourage people with papulopustular rosacea to use photoprotection with sunscreen, regularly cleanse, avoid food and alcohol triggers, and avoid stress and temperature changes.

Other papulopustular rosacea treatments include:

• oral antibiotics, such as doxycycline capsules, for anti-inflammatory effects
• oral isotretinoin, also known as Accutane
• azelaic acid
• metronidazole
• sodium sulfacetamide and sulfur
• retinoids
• minocycline

Phymatous rosacea most commonly occurs on the nose. It may also affect the forehead, chin, ears, and eyelids.

Previously, scientists associated this type of rosacea with heavy alcohol use, but recent research has since debunked this theory. Phymatous rosacea occurs more commonly in males than in females.

Symptoms

Phymatous rosacea symptoms include:

• enlarged pores
• thickening of the skin
• irregular surface nodularities, particularly on the nose
• increased volume of sebaceous glands (oil-producing glands in hair follicles)

Treatment

The treatment for phymatous rosacea depends on whether the individual’s condition is inflamed or noninflamed.

For inflamed phymatous rosacea, experts recommend oral doxycycline, oral isotretinoin, or both.

For noninflamed phyma or fibrotic phyma, experts recommend physical modalities, including laser therapy and intense pulsed light (IPL) devices.

With this type of rosacea, inflammation and irritation center on the eye area. It can range from mild irritation to severe disruption of the surface of the eye and inflammation of the cornea, or inflammatory keratitis.

People with ocular rosacea may also experience bouts of conjunctivitis and blepharitis. Many people with ocular rosacea describe the eyes as feeling “gritty.” It can also affect the general area around the eye, with eyelid inflammation and scaly or thick eyelids, as well as corneal ulcers or scars.

While ocular rosacea can become a serious condition in some extreme cases, it is rarely sight threatening. However, it can threaten a person’s sight in serious cases of inflammatory keratitis. Anyone who experiences inflammation of their cornea should seek urgent medical treatment.

Symptoms

Ocular rosacea symptoms include:

• burning, stinging, and itching of the eyes
• light sensitivity
• foreign body or “gritty” sensation in the eyes
• inflammation of the cornea
• blurry vision
• eye area dryness
• scaly, dry, or thick eyelids
• conjunctivitis (pink eye)

Treatment

Aside from the typical lifestyle alterations that can help control rosacea flare-ups, ocular rosacea treatments include:

• gentle cleansers
• warm compresses
• topical steroid creams
• tetracycline antibiotics
• cyclosporine ophthalmic emulsion
• omega-3 fatty acid supplementation
• IPL treatment
• metronidazole

Additionally, experts recommend avoiding the use of eye makeup during flares.

The exact cause of rosacea is unknown and will vary from person to person. Both genetic and environmental factors contribute to rosacea. Some of the factors that influence rosacea include:

• sun exposure
• changes to the small blood vessels of the face, such as blood vessels that dilate too easily
• abnormal immune responses or abnormal inflammatory responses
• microbial exposure, particularly to Demodex mites
• sensitivities to food, such as spicy food
• alcohol consumption
• cigarette smoking
• heat exposure
• stress

Rosacea is three times more likely to affect females than males. However, males tend to experience rosacea more severely, though this may be because they do not seek help until the condition is more advanced.

If someone suspects that they are experiencing one or more of these rosacea subtypes, they should seek treatment from a medical professional.

While it is a common condition and can have very mild symptoms in some cases, rosacea can worsen over time without treatment. In some cases, redness or thickening of the skin can become permanent.

To help prevent rosacea flare-ups, experts generally recommend practicing good skin hygiene, using nonallergenic skin products, and regularly applying sun protection.

People with rosacea can also try to avoid their personal known triggers. For some, this might be limiting or abstaining from alcohol, reducing stress, or avoiding spicy foods. To better understand their triggers, people can also opt to receive an allergy test from a healthcare professional.

Rosacea is a common chronic inflammatory skin condition with four subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular.

Although there is no cure for rosacea, there are many available treatments and methods of prevention that can alleviate symptoms. These will vary depending on the type of rosacea that someone is experiencing.

A person can speak to a healthcare professional for any concerns regarding rosacea.