Key Points

  • Rosacea has 4 different clinical presentations: erythemato-telangiectatic, papulo-pustular, phymatous, and ocular. It is essential to correctly identify the subtype of rosacea in order to select the appropriate medical or surgical therapy.
  • Rosacea treatment should be tailored to the clinical subtype and disease severity to optimize therapy.
  • Facial erythema is the primary feature of rosacea and presents ubiquitously in all subtypes.  Persistent facial erythema has significant impact on quality of life.
  • A new topical treatment option, the alpha adrenergic agonist brimonidine (Mirvaso), is now available to effectively reduce erythema in erythemato-telangiectactic rosacea.
  • Papulo-pustular rosacea must be distinguished from acne vulgaris, seborrheic dermatitis, perioral dermatitis, and Demodex folliculitis (demodicidosis).
  • Rosacea treatment should be tailored to the clinical subtype to optimize therapy.  Erythemato-telangiectatic rosacea must be differentiated from chronic sun damage.
  • Rosacea patients often have sensitive skin and suffer from intolerance to skin products and cosmetics.
  • Patients with rosacea flush, have facial erythema, telangectasia, papules and pustules, sebaceous hyperplasia of the nose (rhinophyma), and/or ocular symptoms. Triggers for flushing include alcohol, sun exposure, hot weather, exercise, ingestion of hot or spicy foods/ drink or a medication, and emotional stress.  Eliminating the triggers of flushing can alleviate rosacea symptoms.
  • Ocular rosacea requires systemic antibiotics.
  • Phymatous rosacea may require laser treatment or other surgical intervention.