Rosacea types and treatments
Because of the potential complexity of rosacea, it has been classified into four subtypes according to signs and symptoms that often occur together. It is possible to have the characteristics of more than one subtype at the same time.
If you think you have rosacea, it’s important to get medical care. Why? Because not only can this vascular, inflammatory condition get worse and potentially cause permanent damage to your skin, it has the ability to psychologically and emotionally impact your life. From avoiding social events to not feeling as self-confident as you once did, rosacea can affect life choices.
Subtype 1. Facial Redness
Medical name: Erythematotelangiectatic rosacea
Symptoms: flushing and persistent redness, may include visible blood vessels, stinging, burning, and swelling.
Erythema—the medical term for redness in rosacea—is associated with just about every subtype of rosacea. In erythematotelangiectatic (subtype 1), the primary symptom of the disease is persistent facial redness. Visible blood vessels (telangiectasia) often occur with this subtype.
Because this subtype is difficult to treat with medical therapy, it may be especially important for you to identify and avoid lifestyle and environmental factors that trigger flushing or irritate your skin. The most common factors are covered in Rosacea Triggers.
- Visible blood vessels and severe background redness may be reduced with lasers or intense pulsed light therapy.
- Several sessions are typically required for satisfactory results, and touch-up sessions may later be needed as the underlying disease process is still present.
- Extensive flushing, in some cases, can be treated with some types of medication, so working with your dermatologist is a must.
Subtype 2. Bumps and pimples
(with some redness, sometimes with swelling and visible blood vessels)
Medical name: Papulopustular rosacea
Symptoms: bumps (papules) or pimples (pustules) that come and go, includes red patches.
Learn about a prescription treatment for papulopustular rosacea.
Rosacea can often be confused with acne. However in rosacea, blackheads (oil-clogged pores) are not usually present and a burning or stinging sensation of the skin can be more common. Rosacea is also primarily found on people’s faces, while acne may also affect the back, shoulders, and chest.
A number of medications have been extensively studied and approved for this common form of rosacea, and may also be used on a long-term basis to prevent recurrence of symptoms.
- Doctors often prescribe oral and topical rosacea therapy to bring the condition under immediate control. Topical metronidazole, azelaic acid, and sodium sulfacetamide/sulfur have been approved by the FDA to treat papulopustular rosacea.
- A version of an oral therapy with less risk of microbial resistance has also been approved specifically for rosacea and has been shown to be safe for long-term use.
- Higher doses of oral antibiotics may also be prescribed, and other drugs may be used for patients who are unresponsive to conventional treatments.
Subtype 3. Skin thickening
Medical name: Phymatous rosacea
Symptoms: excess tissue often results in enlargement of the nose and irregular surface nodules (bump-like lesions).
This form of rosacea is defined by thickened skin, typically around the nose. Many times this type of rosacea is mistakenly identified as “alcoholics’ nose” due to the thick, red skin around the nostrils.
Although mild cases may be treated with medications, moderate to severe manifestations typically require surgery. Surgical options include:
- Radiofrequency ablation
- Electrosurgery tangential excision combined with scissor sculpturing and skin grafting
- A surgical laser can also be used as a bloodless scalpel to remove excess tissue and recontour the nose, often followed by dermabrasion
Subtype 4. Eye irritation
Medical name: Ocular rosacea
Symptoms: watery or bloodshot eyes, tearing and burning, swollen eyelids, recurrent styes.
Ocular rosacea is characterized by any one of many eye symptoms, including a watery or bloodshot appearance, foreign body sensation, burning or stinging, dryness, itching, light sensitivity, and blurred vision. A history of having styes is a strong indication, as well as having "dry eye" or blepharitis.
Treatment for mild to moderate ocular rosacea may include:
- Artificial tears
- Oral antibiotics
- The daily cleansing of the eyelashes with baby shampoo on a wet washcloth
More severe cases should be examined by an eye specialist, who may prescribe ophthalmic treatments, as potential corneal complications may involve the loss of visual acuity.
If you think you have rosacea, it’s important to speak to your doctor about your treatment options and thoroughly understand your choices.