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Rosacea

Clinical Overview and Management

Understanding Rosacea and Treatment Options

Rosacea is a chronic inflammatory skin condition that primarily affects the central face.

It can cause persistent redness, flushing, visible blood vessels, inflammatory lesions and skin sensitivity. Symptoms can vary between individuals and may fluctuate over time.

Central facial redness and flushing characteristic of rosacea
Illustration of blood vessel reactivity and inflammation underlying rosacea

Pathogenesis

The exact cause of rosacea is not fully understood. It is thought to involve a combination of:
  • Vascular hyperreactivity — increased reactivity of the blood vessels, contributing to flushing and persistent redness.
  • Immune dysregulation and inflammation.
  • Demodex overactivity, which may contribute to inflammation in some patients.

Skin barrier dysfunction, resulting in increased sensitivity and irritation.

Types of Rosacea

Rosacea can present in several different clinical forms, including:

  • Erythematotelangiectatic rosacea (ETR)
  • Papulopustular rosacea (PPR)
  • Phymatous rosacea
  • Ocular rosacea

Some patients may experience features of more than one subtype.

Contributing Factors

Rosacea can be aggravated by a range of environmental and lifestyle factors. Common triggers include:

  • Heat
  • Sun exposure
  • Alcohol
  • Spicy foods
  • Exercise
  • Stress
  • Irritating skincare products
Genetic factors and Demodex may also contribute in some individuals.

Grading

Rosacea is assessed according to a number of clinical features, including:
  • Severity and persistence of erythema
  • Frequency of flushing
  • Inflammatory papules and pustules
  • Presence of telangiectasia
  • Ocular involvement
  • Skin thickening or phymatous change
  • Impact on quality of life

Treatment by Severity

Gentle skincare treatment for mild rosacea including azelaic acid and metronidazole

Mild

Trigger avoidance, gentle skincare, metronidazole, azelaic acid, brimonidine/oxymetazoline.
IPL and vascular laser treatment for moderate rosacea

Moderate

Combination topicals, low-dose doxycycline, IPL/vascular lasers.

Advanced vascular laser and clinic treatment for moderate to severe rosacea

Moderate–Severe

Ivermectin, prolonged doxycycline, advanced vascular lasers, ocular management.

Dermatologist consultation for severe rosacea including rhinophyma management

Severe

Isotretinoin, surgical reshaping for rhinophyma.