Highlights & Basics
- Rosacea, a common chronic disorder of the skin, is usually a clinical diagnosis; avoidance of triggers is key to management.
- The most common manifestations are flushing, dilated prominent telangiectases (primarily on the face), persistent facial erythema, inflammatory papules, and pustules on the periorificial face.
- Prominence of sebaceous glands on the nose may result in fibrosis and rhinophyma.
- Typically, mild disease is initially treated with topical metronidazole or oral tetracyclines. Other antibiotics and anti-inflammatory agents can be used as adjuncts.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Citations
Gallo RL, Granstein RD, Kang S, et al. Standard classification and pathophysiology of rosacea: the 2017 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. 2018 Jan;78(1):148-55.[Abstract]
Hampton PJ, Berth-Jones J, Duarte Williamson CE, et al. British Association of Dermatologists guidelines for the management of people with rosacea 2021. Br J Dermatol. 2021 Oct;185(4):725-35.[Abstract][Full Text]
Del Rosso JQ, Tanghetti E, Webster G, et al. Update on the management of rosacea from the American Acne & Rosacea Society (AARS). J Clin Aesthet Dermatol. 2020 Jun;13(6 suppl):S17-S24.[Abstract][Full Text]
Thiboutot D, Anderson R, Cook-Bolden F, et al. Standard management options for rosacea: the 2019 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. 2020 Jun;82(6):1501-10.[Abstract]
College of Optometrists. Clinical management guidelines: ocular rosacea. Aug 2021 [internet publication].[Full Text]
1. Gallo RL, Granstein RD, Kang S, et al. Standard classification and pathophysiology of rosacea: the 2017 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. 2018 Jan;78(1):148-55.[Abstract]
2. Donshik PC, Hoss DM, Ehlers WH. Inflammatory and papulosquamous disorders of the skin and eye. Dermatol Clin. 1992 Jul;10(3):533-47.[Abstract]
3. Drolet B, Paller AS. Childhood rosacea. Pediatr Dermatol. 1992 Mar;9(1):22-6.[Abstract]
4. Al-Dabagh A, Davis SA, McMichael AJ, et al. Rosacea in skin of color: not a rare diagnosis. Dermatol Online J. 2014 Oct 15;20(10):13030/qt1mv9r0ss.[Abstract]
5. Alexis AF, Callender VD, Baldwin HE, et al. Global epidemiology and clinical spectrum of rosacea, highlighting skin of color: review and clinical practice experience. J Am Acad Dermatol. 2019 Jun;80(6):1722-9.e7.[Abstract][Full Text]
6. Two AM, Wu W, Gallo RL, et al. Rosacea: part I. Introduction, categorization, histology, pathogenesis, and risk factors. J Am Acad Dermatol. 2015 May;72(5):749-58.[Abstract]
7. Tan J, Schöfer H, Araviiskaia E, et al. Prevalence of rosacea in the general population of Germany and Russia - The RISE study. J Eur Acad Dermatol Venereol. 2016 Mar;30(3):428-34.[Abstract][Full Text]
8. Gether L, Overgaard LK, Egeberg A, et al. Incidence and prevalence of rosacea: a systematic review and meta-analysis. Br J Dermatol. 2018 Aug;179(2):282-9.[Abstract][Full Text]
9. Spoendlin J, Voegel JJ, Jick SS, et al. A study on the epidemiology of rosacea in the U.K. Br J Dermatol. 2012 Sep;167(3):598-605.[Abstract]
10. Yamasaki K, Gallo RL. The molecular pathology of rosacea. J Dermatol Sci. 2009 Aug;55(2):77-81.[Abstract][Full Text]
11. Morgado-Carrasco D, Granger C, Trullas C, et al. Impact of ultraviolet radiation and exposome on rosacea: key role of photoprotection in optimizing treatment. J Cosmet Dermatol. 2021 Nov;20(11):3415-21.[Abstract][Full Text]
12. Deng Z, Chen M, Xie H, et al. Claudin reduction may relate to an impaired skin barrier in rosacea. J Dermatol. 2019 Apr;46(4):314-21.[Abstract]
13. Aldrich N, Gerstenblith M, Fu P, et al. Genetic vs environmental factors that correlate with rosacea: a cohort-based survey of twins. JAMA Dermatol. 2015 Nov;151(11):1213-9.[Abstract][Full Text]
14. Hampton PJ, Berth-Jones J, Duarte Williamson CE, et al. British Association of Dermatologists guidelines for the management of people with rosacea 2021. Br J Dermatol. 2021 Oct;185(4):725-35.[Abstract][Full Text]
15. Del Rosso JQ, Tanghetti E, Webster G, et al. Update on the management of rosacea from the American Acne & Rosacea Society (AARS). J Clin Aesthet Dermatol. 2020 Jun;13(6 suppl):S17-S24.[Abstract][Full Text]
16. Thiboutot D, Anderson R, Cook-Bolden F, et al. Standard management options for rosacea: the 2019 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. 2020 Jun;82(6):1501-10.[Abstract]
17. Chen AY, Zirwas MJ. Steroid-induced rosacealike dermatitis: case report and review of the literature. Cutis. 2009 Apr;83(4):198-204.[Abstract]
18. Hoepfner A, Marsela E, Clanner-Engelshofen BM, et al. Rosacea and perioral dermatitis: a single-center retrospective analysis of the clinical presentation of 1032 patients. J Dtsch Dermatol Ges. 2020 Jun;18(6):561-70.[Abstract][Full Text]
19. Holmes AD. Potential role of microorganisms in the pathogenesis of rosacea. J Am Acad Dermatol. 2013 Dec;69(6):1025-32.[Abstract]
20. Elewski BE, Draelos Z, Dréno B, et al. Rosacea - global diversity and optimized outcome: proposed international consensus from the Rosacea International Expert Group. J Eur Acad Dermatol Venereol. 2011 Feb;25(2):188-200.[Abstract]
21. Yamasaki K, Di Nardo A, Bardan A, et al. Increased serine protease activity and cathelicidin promotes skin inflammation in rosacea. Nat Med. 2007 Aug;13(8):975-80.[Abstract]
22. Yoon SH, Hwang I, Lee E, et al. Antimicrobial peptide LL-37 drives rosacea-like skin inflammation in an NLRP3-dependent manner. J Invest Dermatol. 2021 Dec;141(12):2885-94.e5.[Abstract]
23. Zhang J, Jiang P, Sheng L, et al. A novel mechanism of carvedilol efficacy for rosacea treatment: Toll-like receptor 2 Inhibition in macrophages. Front Immunol. 2021 Jul 12;12:609615.[Abstract][Full Text]
24. Muto Y, Wang Z, Vanderberghe M, et al. Mast cells are key mediators of cathelicidin-initiated skin inflammation in rosacea. J Invest Dermatol. 2014 Nov;134(11):2728-36.[Abstract][Full Text]
25. Yamasaki K, Kanada K, Macleod DT, et al. TLR2 expression is increased in rosacea and stimulates enhanced serine protease production by keratinocytes. J Invest Dermatol. 2011 Mar;131(3):688-97.[Abstract][Full Text]
26. Steinhoff M, Schauber J, Leyden JJ. New insights into rosacea pathophysiology: a review of recent findings. J Am Acad Dermatol. 2013 Dec;69(6 suppl 1):S15-26.[Abstract]
27. Buhl T, Sulk M, Nowak P, et al. Molecular and morphological characterization of inflammatory infiltrate in rosacea reveals activation of Th1/Th17 pathways. J Invest Dermatol. 2015 Sep;135(9):2198-208.[Abstract][Full Text]
28. Abokwidir M, Fleischer AB Jr. Additional evidence that rosacea pathogenesis may involve demodex: new information from the topical efficacy of ivermectin and praziquantel. Dermatol Online J. 2015 Sep 17;21(9):13030/qt13v249f5.[Abstract]
29. Parodi A, Paolino S, Greco A, et al. Small intestinal bacterial overgrowth in rosacea: clinical effectiveness of its eradication. Clin Gastroenterol Hepatol. 2008 Jul;6(7):759-64.[Abstract]
30. Jørgensen AR, Egeberg A, Gideonsson R, et al. Rosacea is associated with Helicobacter pylori: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2017 Dec;31(12):2010-5.[Abstract]
31. Sibenge S, Gawkrodger DJ. Rosacea: a study of clinical patterns, blood flow, and the role of Demodex folliculorum. J Am Acad Dermatol. 1992 Apr;26(4):590-3.[Abstract]
32. Guzman-Sanchez DA, Ishiuji Y, Patel T, et al. Enhanced skin blood flow and sensitivity to noxious heat stimuli in papulopustular rosacea. J Am Acad Dermatol. 2007 Nov;57(5):800-5.[Abstract]
33. Woo YR, Lim JH, Cho DH, et al. Rosacea: molecular mechanisms and management of a chronic cutaneous inflammatory condition. Int J Mol Sci. 2016 Sep 15;17(9):1562.[Abstract][Full Text]
34. Kulkarni NN, Takahashi T, Sanford JA, et al. Innate immune dysfunction in rosacea promotes photosensitivity and vascular adhesion molecule expression. J Invest Dermatol. 2020 Mar;140(3):645-55.e6.[Abstract][Full Text]
35. Chang ALS, Raber I, Xu J, et al. Assessment of the genetic basis of rosacea by genome-wide association study. J Invest Dermatol. 2015 Jun;135(6):1548-55.[Abstract][Full Text]
36. Hayran Y, Lay I, Mocan MC, et al. Vascular endothelial growth factor gene polymorphisms in patients with rosacea: A case-control study. J Am Acad Dermatol. 2019 Aug;81(2):348-54.[Abstract]
37. Yuan X, Huang X, Wang B, et al. Relationship between rosacea and dietary factors: a multicenter retrospective case-control survey. J Dermatol. 2019 Mar;46(3):219-25.[Abstract]
38. Powell FC. Clinical practice. Rosacea. New Engl J Med. 2005 Feb 24;352(8):793-803.[Abstract]
39. Schaller M, Almeida LMC, Bewley A, et al. Recommendations for rosacea diagnosis, classification and management: update from the global ROSacea COnsensus 2019 panel. Br J Dermatol. 2020 May;182(5):1269-76.[Abstract][Full Text]
40. College of Optometrists. Clinical management guidelines: ocular rosacea. Aug 2021 [internet publication].[Full Text]
41. Segarra-Newnham M, Karimi S. Overview of the pharmacologic options for rosacea. J Pharm Technol. 2009 Nov;25(6):368-73.
42. van Zuuren EJ, Fedorowicz Z, Carter B, et al. Interventions for rosacea. Cochrane Database Syst Rev. 2015 Apr 28;(4):CD003262.[Abstract][Full Text]
43. van Zuuren EJ, Gupta AK, Gover MD, et al. Systematic review of rosacea treatments. J Am Acad Dermatol. 2007 Jan;56(1):107-15.[Abstract]
44. Gold LS, Papp K, Lynde C, et al. Treatment of rosacea with concomitant use of topical ivermectin 1% cream and brimonidine 0.33% gel: a randomized, vehicle-controlled study. J Drugs Dermatol. 2017 Sep 1;16(9):909-16.[Abstract]
45. van Zuuren EJ, Fedorowicz Z, Tan J, et al. Interventions for rosacea based on the phenotype approach: an updated systematic review including GRADE assessments. Br J Dermatol. 2019 Jul;181(1):65-79.[Abstract][Full Text]
46. Berth-Jones J, Clark SM, Henderson CA. Rosacea and perioral dermatitis. In: Lebwohl MG, Heymann WR, Berth-Jones J, et al, eds. Treatment of skin disease. Edinburgh: Mosby; 2002:561-7.
47. Krupashankar DS; IADVL Dermatosurgery Task Force. Standard guidelines of care: CO2 laser for removal of benign skin lesions and resurfacing. Indian J Dermatol Venereol Leprol. 2008 Jan;74 Suppl:S61-7.[Abstract][Full Text]
48. Metelitsa AI, Alster TS. Fractionated laser skin resurfacing treatment complications: a review. Dermatol Surg. 2010 Mar;36(3):299-306.[Abstract][Full Text]
49. Raoufinejad K, Mansouri P, Rajabi M, et al. Efficacy and safety of permethrin 5% topical gel vs. placebo for rosacea: a double-blind randomized controlled clinical trial. J Eur Acad Dermatol Venereol. 2016 Dec;30(12):2105-17.[Abstract]
50. Ebneyamin E, Mansouri P, Rajabi M, et al. The efficacy and safety of permethrin 2.5% with tea tree oil gel on rosacea treatment: a double-blind, controlled clinical trial. J Cosmet Dermatol. 2020 Jun;19(6):1426-31.[Abstract]
51. Neuhaus IM, Zane LT, Tope WD. Comparative efficacy of nonpurpuragenic pulsed dye laser and intense pulsed light for erythematotelangiectatic rosacea. Dermatol Surg. 2009 Jun;35(6):920-8.[Abstract]
52. Bhargava R, Chandra M, Bansal U, et al. A randomized controlled trial of omega 3 fatty acids in rosacea patients with dry eye symptoms. Curr Eye Res. 2016 Oct;41(10):1274-80.[Abstract]
53. Zandian M, Rahimian N, Soheilifar S. Comparison of therapeutic effects of topical azithromycin solution and systemic doxycycline on posterior blepharitis. Int J Ophthalmol. 2016 Jul 18;9(7):1016-9.[Abstract][Full Text]
54. Yildiz E, Yenerel NM, Turan-Yardimci A, et al. Comparison of the clinical efficacy of topical and systemic azithromycin treatment for posterior blepharitis. J Ocul Pharmacol Ther. 2018 May;34(4):365-72.[Abstract]
55. Schechter BA, Katz RS, Friedman LS, et al. Efficacy of topical cyclosporine for the treatment of ocular rosacea. Adv Ther. 2009 Jun;26(6):651-9.[Abstract]
56. Clark DP, Hanke CW. Electrosurgical treatment of rhinophyma. J Am Acad Dermatol. 1990 May;22(5 Pt 1):831-7.[Abstract]
57. Berardesca E, Iorizzo M, Abril E, et al. Clinical and instrumental assessment of the effects of a new product based on hydroxypropyl chitosan and potassium azeloyl diglycinate in the management of rosacea. J Cosmet Dermatol. 2012 Mar;11(1):37-41.[Abstract][Full Text]
58. Veraldi S, Raia DD, Schianchi R, et al. Treatment of symptoms of erythemato-telangiectatic rosacea with topical potassium azeloyl diglycinate and hydroxypropyl chitosan: results of a sponsor-free, multicenter, open study. J Dermatolog Treat. 2015 Apr;26(2):191-2.[Abstract]
