Rosacea may divided into subtypes based on the clinical appearance of the lesions. Clinical features may overlap in some patients.


Main subtypes:

(1) erythematotelangiectatic (ETR, erythema + telangiectasia)

(2) papulopustular (PPR)

(3) phymatous

(4) ocular


Other subtypes:

(5) glandular (GR)


Features of erythematotelangiectatic subtype:

(1) prolonged flushing following stimulus, usually affecting the central portion of the face but sometimes involving other sites including the chest

(2) there is sparing of the periocular skin

(3) sensitivity to topical agents with burning, stinging and/or itching

(4) presence of skin that has a fine texture, lacking sebaceous qualities or oiliness

(5) scaling and telangiectasia may develop over time


Features of papulopustular subtype:

(1) striking red coloration to the central portion of the face

(2) presence of small papules with tiny pustules

(3) there is sparing of the periocular skin

(4) flushing and telangiectasia are less prominent than in the ETR subtype


Features of phymatous subtype:

(1) presence of thick, sebaceous skin with irregular surface nodularities

(2) growth or enlargement ("phyma") may occur in:

(2a) nose (rhinophyma)

(2b) chin (gnathophyma)

(2c) forehead (rhetophyma)

(2d) ears (otophyma)

(2e) eyelids (blepharophyma)


Features of ocular subtype:

(1) involvement of periocular skin with blepharitis and conjunctivitis

(2) presence of ocular findings may include interpalpebral conjunctival hyperemia, telangiectasia, irritation, and dryness

(3) burning, stinging or itching of the eyes

(4) sensitivity to light

(5) foreign body sensation


Features of glandular subtype:

(1) more common in males

(2) presence of thick, sebaceous skin

(3) presence of edematous papules and independent pustules

(4) variable presence of nodulocystic lesions

(5) usually there is an absence of sensitivity to topical agents, with absence of burning and stinging

(6) absence of periocular lesions

(7) variable development of rhinophyma

(8) often there is a history of severe acne during adolescence


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