4.1.2 Rosacea

Grading & Level of Importance: B






Incidence: 165/100 000 per year, prevalence: 1 - 22% (great variation).
Individuals with fair skin type have an increased risk.
Age of onset 30 to 50 years.


Centrofacial, chronic, inflammatory disease.

Aetiology & Pathogenesis

Multifactorial etiology: Environmental trigger factors, demodex, nutritional factors (alcohol, histamine releaser), exercise, acute psychological stress, menstruation, medications.

Pathogenesis: Impaired permeability barrier in the stratum corneum, antimicrobial peptides, overexpression of Toll-like receptors, inflammatory cells, reactive oxygen species, neoangiogenesis, sensory nerve activation.

Signs & Symptoms

Centrofacial transient erythema (flushing), teleangiectatic erythema, papules and pustules without comedones, phymas (rhinophyma, gnathophyma, metophyma), bilateral conjuctivitis, stinging and burning sensations.


Mid-face, forehead, nose, conjuctiva, V-area of chest.


Type I (teleangiectatic)

Type II (papulopustular)

Type III (phymatous)

Ocular rosacea

Morbihan’s disease

Laboratory & other workups

Skin biopsy for ruling out other facial dermatoses. Cyanoacrylate tapestrip for demodex detection.


All subtypes show dilated lymph and blood vessels in the upper and mid-dermis and a superficial perivascular and perifollicular mononuclear lympho-histiocytic infiltrate. Widened follicles. Oedema and thickened elastic fibres may be seen. Type III: hyperplastic sebaceous glands, granuloma formation.


Progressive and chronic.


Proliferation of connective tissue and sebaceous follicles: rhinophyma (enlarged nose), otophyma (ears), metophyma (forehead), gnathophyma (chin). Rosacea fulminans and rosacea conglobata = maximal variants of rosacea. Keratitis in ocular rosacea.


Clinical findings. 

Differential diagnosis

Major: Late-onset acne, corticosteroid-induced acne, periorificial dermatitis. In stage I also lupus erythematosus. If lupoid: sarcoidosis (lupus pernio), erysipelas.

Prevention & Therapy

Elimination of triggers. 

Type I: Topical: Brimonidine tartrate 
Procedures: Nd:YAG LASER, pulsed dye LASER, intense pulsed light (IPL).

Type II: Topical: Metronidazole, azelaic acid, ivermectin 1%, permethrin 5% pimecrolimus, retinoids - Systemic: Low dose doxycycline, low dose isotretinoin.

Type III: Systemic: Isotretinoin - Procedures: Dermabrasion, ablative LASERS (for phymas).

Ocular rosacea: Systemic doxycycline.

Mark article as unread
Article has been read
Mark article as read


Be the first one to leave a comment!