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Rosacea
See also in: Cellulitis DDx,External and Internal Eye
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Rosacea

See also in: Cellulitis DDx,External and Internal Eye
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Contributors: Lauren Strazzula MD, Susan Burgin MD, Lowell A. Goldsmith MD, MPH
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Synopsis

Rosacea is a common, chronic inflammatory condition with a relapsing-remitting course. It presents with facial flushing and localized erythema, telangiectases, papules, and pustules on the nose, cheeks, brow, and chin. It commonly develops in individuals between the ages of 30 and 50.

The etiology of rosacea is poorly understood. Cutaneous vascular changes, inappropriate activation of the immune system, UV and microbial exposure (ie, Demodex mites), and disruption of the epidermal barrier have all been implicated as playing a role in the pathogenesis in this condition. There have been reports of familial rosacea, so an underlying genetic predisposition has not been ruled out.

Rosacea primarily affects individuals with lighter skin phototypes, and females tend to present at a younger age than males. The disease is reported less commonly in skin types IV-VI, perhaps because darker skin types are less prone to photodamage, and flushing and telangiectasias are harder to visualize.

There are 4 main subtypes of the disease: erythematotelangiectatic, papulopustular, phymatous, and ocular rosacea.
  1. Erythematotelangiectatic rosacea – Presents with persistent erythema of the central portion of the face with intermittent flushing. Telangiectasias can also occur. Patients often complain of stinging or burning sensations on the skin. This is the most common subtype.
  2. Papulopustular rosacea – Acneiform papules and pustules predominate; there is also erythema and edema of the central face with relative sparing of the periocular areas. Dramatic swelling can result in lymphedematous changes manifesting as solid facial edema or lead to phymatous changes.
  3. Phymatous rosacea – Chronic inflammation and edema result in marked thickening of the skin with sebaceous hyperplasia, resulting in an enlarged, cobblestoned appearance of affected skin, most commonly on the nose (rhinophyma). Men are more often affected.
  4. Ocular rosacea – Presents with conjunctivitis, blepharitis, and hyperemia. Patients complain of dry, irritated, itchy eyes. Keratitis, scleritis, and iritis are potential but infrequent complications. Ocular rosacea can occur in patients with or without cutaneous findings.
A granulomatous variant has also been defined and is characterized by papules, nodules, and yellow-brown pustules distributed on the central face, eyelids, forehead, cheeks, nasolabial folds, and periocular and perioral regions. It is often described as noninflammatory and may be unilateral. Flushing is less common.

Rosacea fulminans (pyoderma faciale) refers to the sudden onset of inflammatory facial papules and pustules with possible abscess and sinus tract formation. Systemic signs and symptoms are present.

A rare consequence of chronic rosacea and certain other facial disorders is solid facial edema, sometimes called Morbihan disease.

Since rosacea manifests on the face, it is important to recognize that this disease can have psychosocial consequences, which may affect quality of life.

Codes

ICD10CM:
L71.9 – Rosacea, unspecified

SNOMEDCT:
398909004 – Rosacea

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Papulopustular rosacea:
Erythematotelangiectatic rosacea:
Causes of flushing:
Ocular rosacea:

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated: 03/21/2019
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Rosacea
See also in: Cellulitis DDx,External and Internal Eye
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Rosacea : Erythema, Face, Nose, Telangiectasia, Cheeks
Clinical image of Rosacea
Erythema, telangiectasias, and few scattered inflammatory papules on the cheek.

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