A common disorder affecting facial skin.

Initially carries both a vascular and an inflammatory component

– Inflammatory: Papules, pustules

– Vascular: Erythema, telangiectasia, flushing




  • -Symmetrical localization on the face; may be asymmetrical
  • -Nose, cheeks, forehead, chin
  • -May involve a variety of ocular lesions




  • -Unknown
  • -Age – thirty to fifty years at onset (most common);
  • -may occur from adolescence to late adult life
  • -Females predominate, but severity is greater in males
  • -Greater incidence in fair skinned people



Clinical Picture

  • -Flushing – periodic reddening of the face (erythema)
  • -Inflammatory lesions – papules, pustules
  • -Edema may be present
  • -Telangiectasia may be added with time
  • -Ocular rosacea – accompanies vascular cutaneous rosacea
  • -Comedones are characteristically absent
  • -Diagnosis is made on a clinical basis
  • -Rhinophyma is a late finding



Early Clues To Rosacea

  • -Recurrent flushing, blushing; may last several minutes – several hours
  • -Stinging in the malar areas, forehead, ears
  • -Facial edema may be present



Rosacea Often Progresses In The Following Steps

  • -Pre-rosacea ===> Flushing and blushing
  • -Vascular Rosacea ===> Erythema and telangiectasia
  • -Inflammatory Rosacea ===> Papules and pustules
  • -Late Rosacea ===> Rhinophyma



Facial Flushing

  • -Is a prominent feature of rosacea
  • -Is usually the initial manifestation of the disease
  • -Worsens during inflammatory outbreaks
  • -Patients should avoid activities and aggravating factors which induce flushing




  • -Enlargement of the nose
  • -More common in males
  • -Skin thickens
  • -Enlarged follicles
  • -Hyperplasia of sebaceous glands, connective tissue



Pathogenesis: Theories Proposed

  • -Demodex folliculorum
  • -Psychogenic stress
  • -Endocrine abnormalities
  • -Focal infection
  • -Vascular disorder
  • -Diet



Vascular Disorders

  • -Leaky vessels
  • -Insufficient blood flow
  • -“Pooling effect”
  • -Connective tissue dystrophy – leads to dilation of blood vessels



Rosacea – Aggravating Factors

  • -Hot liquids
  • -Sun exposure, wind exposure
  • -Spicy foods
  • -Extreme temperatures
  • -Alcoholic beverages
  • -Stress and other psychological factors
  • -Prolonged use of topical fluorinated corticosteroids



Differential Diagnosis

  • -Acne vulgaris
  • -Seborrheic dermatitis
  • -Perioral dermatitis
  • -Lupus erythematosus
  • -Carcinoid syndrome
  • -Some may exist



perioral dermatitis



Course Of Rosacea

  • -Chronic, progressive disease
  • -Periodic exacerbations and remissions common
  • -May slowly increase in extent
  • -Inflammatory ocular complications may occur
  • -Long-term therapy may be required



Topical Steroids – Are Best Avoided

  • -Can cause rebound erythema
  • -Can worsen the condition in long run, although may effect impressive short-term improvement
  • -If used, should be low potency for short time period



Methods Of Treatment

  • -Oral antibiotics – tetracycline and others
  • -Topical formulations – metronidazole topical gel and others (brominidine…)
  • -Many patients will do well with topical therapy alone.
  • -For some patients, the addition for oral tetracycline for several weeks may accelerate initial response to therapy.
  • -Low dose isotretinoin has been shown to be useful
  • -Erythema can respond to lasers.
  • -Lifestyle changes are also an important aspect of the overall treatment plan.
  • .Avoidance of situations and factors that aggravate rosacea should be emphasized.



Answers To Common Patient Questions



1. Question: I have very sensitive skin due to my rosacea. How can I clean my face without causing additional irritation?

Answer: Only very mild soaps or mild cleansers should be used on the face. Avoid products containing alcohol or witch hazel.



2. Question : What about cosmetic use? Can I continue to wear cosmetics?

Answer: Yes, but use of high quality mosturizers and oil-free cosmetic products are recommended. Sunscreens of SPF 15 or higher should be used when prolonged sun exposure is expected. To reduce the redness or a rosacea flare, a green-based concealer may be used.



3. Question: Can anything make rosacea worse?

Answer: Certain things are known to aggravate rosacea. These include hot liquids, alcohol, spicy foods, extremes of temperature and stress.