RosaceaNet Article
Rosacea has many Signs and Symptoms

When people think of rosacea, a red face often comes to mind. But there are many signs (what you see) and symptoms (what a person feels) of rosacea. Researchers have separated these signs and symptoms into four subtypes (special type within a general type) of rosacea. Each subtype requires different treatment.

The following lists the signs and symptoms through a classification system that rosacea experts created. To be diagnosed with rosacea, a person must have at least one of the primary features. They also tend to have several secondary features.

Primary Features of Rosacea
The following are the primary features of rosacea, and a person must have one or more of these on the mid-face:

  • Flushing that comes and goes

  • Persistent flushing

  • Bumps and pimples

  • Visible blood vessels

While having one or more of these features does not mean a person has rosacea, without one of these features a diagnosis of rosacea is rare.


Secondary Features of Rosacea
Rosacea sufferers with primary features also tend to have one or more of the following signs and symptoms, which are the secondary features. However, some people may experience only one or more of these secondary features:

  • Burning or stinging of facial skin

  • Raised red patches

  • Appearance of dry skin

  • Facial swelling

  • Eye problems, such as burning or itching, sties or chalazia (cyst of the eyelid)

  • One or more primary feature (listed above) on another area of the body

  • Thickening of the skin, such as rhinophyma, which is a thickening of the skin on the nose


Four Subtypes of Rosacea
Rosacea experts created four distinct subtypes (when primary and secondary features commonly occur together). They agree that rosacea patients may have the signs and symptoms of more than one subtype at the same time.

Subtype 1: Facial Redness, Flushing, Visible Blood Vessles
Subtype: Erythematotelangiectatic type rosacea

Signs and symptoms:

  • Flushing and persistent redness of the central face (main characteristic)

  • Visible blood vessels often seen

  • Swelling of the central face

  • Stinging and burning sensations

  • Dry skin, roughness or scaling

  • A history of flushing (This alone is common among patients with this subtype.)

Facial redness

Rosacea Subtype 1

 (Photo used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides)


Subtype 2: Bumps and Pus-filled Lesions
Subtype: Papulopustular rosacea

Signs and symptoms:

  • Acne-like bumps and pus-filled lesions form, which is why this subtype is often called “acne rosacea.” The breakouts tend to come and go and may appear along with persistent facial redness, primarily on the central face.

  • Burning and stinging sensations may occur

  • Visible blood vessels may be present

Acne rosacea

Rosacea Subtype 2

(Photo used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides)


Subtype 3: Thickening Skin
Subtype: Phymatous rosacea

Signs:

  • Thickening skin

  • Irregular skin texture and enlarging skin, especially of the nose—may also occur on the chin, forehead, cheeks and ear

  • Visible blood vessels or large pores may appear in the affected area

  • This subtype frequently occurs with or follows another subtype

Rosacea rhinophyma

Rosacea Subtype 3

 (Photo used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides)


Subtype 4: Eye Problems
Subtype: Ocular rosacea

This subtype affects the eyes, which may show one or more of the following signs and symptoms:

  • Watery or bloodshot appearance

  • Sensation of a foreign body in the eye

  • Burning or stinging

  • Dryness

  • Itching

  • Light sensitivity

  • Blurred vision

  • Visible blood vessels in the eye or on an eyelid

  • Cyst on the eyelid

  • Decreased visual sharpness

Ocular rosacea

Rosacea Subtype 4

(Photo used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides)

Loss of vision poses a serious risk with this subtype, and an ophthalmologist (physician who specializes in treatment of eye diseases) may need to be consulted when signs and symptoms affect the eye.

Signs and symptoms that occur when rosacea affects the skin are also usually present in Subtype 4, but not always.

References:
Crawford GH, Pelle MT, James WD. “Rosacea: I. Etiology, pathogenesis, and subtype classification.” Journal of the American Academy of Dermatology September 2004; 51: 327-41.

Wilkin, J, Dahl M, Detmar M et al. “Standard grading system for rosacea: report of the National Rosacea Society Expert Committee on the classification and staging of rosacea.” Journal of the American Academy of Dermatology June 2004; 50: 907-12.


All content solely developed by the American Academy of Dermatology

While rosacea most frequently appears on the face, it also may occur on the ears, scalp, neck, chest, and back. One subtype of rosacea affects the eyes.


 


 

 

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