Meet Your Patient
A 36 year old White woman presents with persistent facial redness that has worsened over several years. She initially attributed the redness on her cheeks to sun exposure, but despite diligent sunscreen use, symptoms have persisted. She denies ocular symptoms. On exam, you note central facial erythema with scattered pustules and visible telangiectasias.
The presentation is consistent with a common condition: rosacea.
Clinical Takeaways
- Rosacea is a clinical diagnosis marked by central facial erythema, flushing, and inflammatory lesions; laboratory testing is rarely required.
- Triggers matter, meaning sun exposure, heat, exercise, and emotional stress commonly worsen symptoms and should be addressed alongside medication.
- Management is longterm, combining trigger avoidance with topical and, when needed, systemic therapies for a relapsing-remitting condition.
What Is Rosacea?
Rosacea is a chronic inflammatory skin condition characterized by episodic facial flushing and persistent central facial erythema. Common features include telangiectasias, papules, and pustules involving the cheeks, nose, brow, and chin.
Several clinical patterns are recognized, most commonly erythematotelangiectatic rosacea. Other recognized subtypes include papulopustular, ocular, phymatous, and granulomatous forms, and patients may present with features of more than one subtype. Less commonly encountered manifestations include rosacea fulminans (pyoderma faciale) and Morbihan disease (solid facial edema).
Rosacea occurs in all populations but is most frequently diagnosed in light skinned individuals. It affects women more often than men and typically presents between ages 30 and 50, though onset may occur at any age.
Because rosacea primarily affects the face, it can have meaningful psychosocial consequences and negatively impact quality of life.
Rosacea is a clinical diagnosis.
Common Triggers
Sun exposure, exercise, emotional stress, and temperature extremes commonly precipitate flares or intensify symptoms. Other triggers include factors that promote vasodilation, such as hot beverages, spicy foods, chocolate, and alcohol.
When Should You Consider Other Diagnoses?
Not all flushing is rosacea. The presence of systemic symptoms, such as palpitations, lightheadedness, syncope, or excessive sweating, should prompt consideration of alternative diagnoses. Conditions including pheochromocytoma, carcinoid syndrome, and autoimmune disorders may present with overlapping features and warrant further evaluation.
Treatment Options and Expectations
There is no single best treatment for rosacea. Management is guided by disease severity and symptom pattern and typically combines trigger avoidance with pharmacologic therapy. Options may include topical agents, oral antibiotics, or other targeted therapies, used alone or in combination. Light based therapies and surgical interventions may be appropriate in select cases.
Supportive measures are important. Regular use of broad spectrum sunscreen and sun avoidance are recommended, and green or yellow tinted camouflage cosmetics may help mask persistent erythema.
Longterm management focuses on symptom control, patient education, and expectation-setting for a relapsing-remitting course.
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