Rosacea – From New Classification to Latest Treatments: All You Need to Know


Rosacea is a common chronic inflammatory disease that presents with recurrent facial redness, flushing, and visible blood vessels.

Rosacea tends to affect the central portion of the face, including the cheeks, nose, chin, and forehead. It also causes bumps, pimples, and thickened skin around the nose. A study [1] in 2018 concluded that around 5.46% of the population worldwide is affected by this condition, mostly people aged 45-60 years. 

Classification of Rosacea: Moving Away from the Age-Old System

The classification system [2] widely used is based on its morphologic features: erythematotelangiectatic (ETR), papulopustular (PPR), phymatous, and ocular rosacea (Figure 1). However, these subtypes are not always practical since many patients have signs and symptoms of more than one type of rosacea, which led to the new classification system based on phenotypes or observable characteristics of the disease. 

Figure 1: Morphologic-based classification system of rosacea

Over the past decade, Galderma[3] worked with the National Rosacea Society Expert Committee to reclassify Rosacea into 3 phenotypes: diagnostic, major, and secondary phenotypes.

Diagnostic phenotypes include fixed centrofacial erythema and phymatous changes and the presence of either one of these is adequate to confirm the diagnosis of Rosacea. In the absence of diagnostic phenotypes, a patient must have two major phenotypes to satisfy a Rosacea diagnosis. Major phenotypes include the presence of dome-shaped red papules and pustules, intermittent facial flushing or blushing, telangiectasias or ocular manifestations. A summary table is shown below.

You might be wondering, doesn’t this look like pimples as well? Indeed they can sometimes look very similar, but there are some key differences:

Criteria Rosacea Pimples
Location Typically affects the central portion of the face, including cheeks, nose, chin and forehead Can appear anywhere on the face
Texture Can cause thickened skin and visible blood vessels Typically raised, red bumps
Triggers Environmental factors (sun exposure, emotional stress, certain foods) Various factors, including hormonal changes
Age of onset Typically develops in adults over the age of 30 Can affect people of all ages, but is more common in teenagers



It can cause a range of symptoms[4], which can vary in severity from person to person. Some common symptoms of rosacea include:

  1. Facial redness: This can appear as a persistent blush or flushing that does not go away.
  2. Visible blood vessels: Small blood vessels may be visible on the face, particularly around the nose.
  3. Bumps and pimples: These can be small and red, or they may be larger and more inflamed.
  4. Thickened skin: Over time, the skin on the nose and cheeks may become thickened and bumpy.
  5. Eye problems: Rosacea can cause eye irritation, redness, and dryness.
  6. Burning or stinging: Some people with rosacea may experience a burning or stinging sensation on their skin.
  7. Swelling: In severe cases, rosacea can cause swelling of the face, particularly around the eyes.

It’s important to note that not everyone with rosacea will experience all of these symptoms, specifically, people living in tropical regions like in southeast Asian countries, if you experience flushes frequently under the sun, it might be a subtle sign of rosacea and require medical attention. 

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