Rosacea

Definition
Rosacea is a chronic, relapsing inflammatory skin condition primarily affecting the central face, characterised by episodes of facial flushing, persistent erythema, telangiectasia, papules, and pustules. It is more common in adults with fair skin and has variable presentations.

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Subtypes

• Erythematotelangiectatic rosacea: Persistent central facial redness, flushing, visible small blood vessels (telangiectasia)

• Papulopustular rosacea: Redness with acne-like papules and pustules (without comedones)

• Phymatous rosacea: Skin thickening and irregular surface (commonly nose — rhinophyma)

• Ocular rosacea: Eye irritation, redness, burning, eyelid inflammation

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Causes & Risk Factors
Exact cause unknown; proposed factors:

• Dysregulation of innate immune system

• Demodex folliculorum mite overgrowth

• Vascular hyperreactivity

• UV light–induced skin damage

• Genetic predisposition

Risk Factors:

• Fair skin (Fitzpatrick I–II)

• Age 30–50 years

• Female sex (though phymatous rosacea more common in men)

• Family history

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Triggers (exacerbating factors)

• Hot or cold weather

• Sun exposure

• Alcohol

• Hot drinks and spicy food

• Emotional stress

• Vigorous exercise

• Certain cosmetics and topical steroids

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Clinical Features

• Persistent facial erythema (nose, cheeks, chin, forehead)

• Flushing episodes lasting >10 minutes

• Telangiectasia

• Papules and pustules without comedones

• Ocular symptoms: burning, gritty sensation, conjunctival hyperaemia, blepharitis

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Diagnosis

• Clinical diagnosis based on characteristic skin changes and distribution

• Dermatoscopy: telangiectasia, absence of comedones

• Exclude acne vulgaris, lupus erythematosus, seborrheic dermatitis

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Treatment

General Measures

• Identify and avoid triggers

• Use gentle skin care with non-soap cleansers

• Apply broad-spectrum sunscreen daily (SPF ≥30)

• Avoid topical corticosteroids on the face

Topical Treatments

• Metronidazole 0.75–1% gel/cream: Apply twice daily

• Azelaic acid 15–20% gel/cream: Apply twice daily

• Ivermectin 1% cream: Apply once daily (targets Demodex mites)

• Brimonidine 0.33% gel: Reduces erythema via vasoconstriction (apply once daily)

Oral Treatments

• Doxycycline (40 mg modified-release daily or 100 mg daily for 6–12 weeks) — anti-inflammatory dose

• Tetracycline or minocycline as alternatives

Procedural

• Laser therapy or intense pulsed light (IPL) for telangiectasia and persistent erythema

• Surgical reshaping for severe rhinophyma

Ocular Rosacea Management

• Lid hygiene, artificial tears, oral doxycycline if severe

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Complications

• Chronic persistent erythema

• Cosmetic disfigurement (especially rhinophyma)

• Corneal damage in untreated ocular rosacea

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Quick-Reference Clinical Chart — Rosacea

Feature	Details
Definition	Chronic facial skin disorder with redness, flushing, and inflammatory lesions
Subtypes	Erythematotelangiectatic, papulopustular, phymatous, ocular
Risk Factors	Fair skin, age 30–50, female sex, family history
Triggers	Sun, heat, alcohol, spicy food, stress, hot drinks
Diagnosis	Clinical; no comedones; central facial distribution
First-Line Topical	Metronidazole, azelaic acid, ivermectin
First-Line Oral	Doxycycline (low-dose anti-inflammatory)
Procedures	Laser/IPL, surgery for rhinophyma
Prevention	Trigger avoidance, daily sunscreen
Prognosis	Chronic relapsing, controllable with treatment