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1. Erythematotelangiectatic Rosacea
- Characterized by flushing and redness
- May also include burning, stinging, roughness & scaling
- Some dilated blood vessels may be present
Rosacea
What is Rosacea?
Overview: Rosacea, also referred to as acne rosacea, is different from acne vulgaris, the type of acne I usually talk about on this web site. Rosacea affects mostly adults over the age of 30, with a higher incidence in women.1-2 People with fair skin are more often affected, although darker skin types may also experience symptoms.2 Rosacea is fairly common (worldwide estimates average about 5% of people), and while its symptoms may wax and wane, it is most often referred to as a chronic condition. Rosacea is usually a progressive disease, and without treatment may continue to worsen over time. Rosacea can also cause emotional repercussions.
Symptoms: Rosacea affects mostly the central part of the face—chin, cheeks, nose, and central forehead. Rosacea is most often characterized by one or more of the following, although none are absolutely required for a diagnosis of rosacea:1-4
- Flushing: The most common sign of rosacea is frequent or sustained blushing or flushing of the skin. The skin of the central face appears red and inflamed. In women, this is not to be confused with monthly flushing before menstruation.
- Papules/pustules: Red, inflamed lesions which may or may not have a white/yellow center. Rosacea does not include non-inflamed whiteheads or blackheads, although one can have rosacea and acne vulgaris simultaneously, so whiteheads or blackheads may be present if this is the case.
- Dilated blood vessels: Called telangiectasia, these dilated blood vessels resemble small squiggles on the surface of the skin. They may be obvious or they may be hidden by the redness of the surrounding skin.
Rosacea symptoms may also include any combination of the following:2-3,5
- Burning or stinging sensation to the skin
- Elevated red plaques
- Dry appearance to the skin
- Fluid under the skin – edema
- Burning or itching eyes, eyelid inflammation, styes, red eyes
- Skin thickening, bulbous growths, rhinophyma
Physicians experience a challenge when diagnosing rosacea because of the numerous ways it can present itself. The National Rosacea Society has broken rosacea into four main categories:2-3
2. Papulopustular Rosacea
- Characterized by redness with papules and pustules present
- May resemble acne vulgaris, but no comedones are present (unless the person has acne vulgaris simultaneously)
- Burning and stinging may be present
- Some dilated blood vessels may be present
3. Phymatous Rosacea
- Thickening of skin
- Irregularities of skin surface. Bumpy appearance
- Rhinophyma: thickening of skin on the nose, resulting in an irregular, bumpy appearance
- Dilated blood vessels
4. Ocular Rosacea
- May include any of the following eye symptoms: watery, bloodshot, burning/stinging, itching, lid redness, stye, light sensitivity, blurred vision, foreign body sensation
- Ocular rosacea is usually present in conjunction with other signs of rosacea on the skin, however, skin symptoms are not required
- Treatment may require topical as well as opthamologic treatment
References
1. Berg M and Lidén S. “An epidemiological study of rosacea.” Acta Dermato-Venereologica. 1989; 69(5): 419-23.
2. Wilkin J, et al. "Standard classification of rosacea: report of the National Rosacea Society Expert Committee on the classification and staging of rosacea." Journal of the American Academy of Dermatology. 2002; 46(4): 584-7.
3. Wilkin J, et al. "Standard grading system for rosacea: report of the National Rosacea Society Expert Committee on the classification and staging of rosacea." Journal of the American Academy of Dermatology. 2004; 50(6): 907-12.
4. Goldgar C, Keahey DJ and Houchins J. "Treatment options for acne rosacea." American Family Physician. 2009; 80(5): 461-468.
5. Del Rosso JQ, Baldwin H and Webster G. "American Acne & Rosacea Society rosacea medical guidelines." Journal of Drugs in Dermatology. 2008; 7(6): 531-533.
