Rosacea is typically classified into 4 main subtypes;
1. Erythematotelangiectatic rosacea
2. Papulopustular rosacea
3. Phymatous rosacea
4. Occular rosacea
There is usually some crossover of symptoms and signs between the four subtypes of rosacea.
In subtype 1 - erythematotelangiectatic rosacea, patients often complain of ‘broken blood vessels’ which refers to the dilated blood vessels that can be seen on the face, usually the cheeks, nose and chin. Flushing can be an additional feature which can cause much anxiety to patients. In addition to this, there is a fixed red colour to the skin which we refer to as persistent erythema.
In patients with papulopustular rosacea - subtype 2, pimple-like lesions occur mostly on the nose and cheeks. These lesions can be pus-filled or simply small red bumps. This form of rosacea can often be mistaken for acne. The key difference however, is the lack of comedones (white heads and blackheads) as well as a lack of lesions on non-facial skin. Patients with rosacea are often also in an older age group compared to acne. Steroid-induced rosacea and peri-oral dermatitis are conditions that can also mimic this type of rosacea, leading to misdiagnosis.
Phymatous rosacea – subtype 3, refers to the thickened and porous skin that is sometimes seen. This most commonly effects men and is most commonly seen on the nose, called rhinophyma. Other areas which can develop similar changes include the chin, forehead and rarely ears and eyelids.
Occular rosacea – subtype 4, is often overlooked and disregarded as a skin condition. Patients often complain of a gritty and dry sensation in their eyes and eyelids, some describing the feeling like having sand stuck in their eyes. The eyelids can appear normal in mild cases, but in more severe cases, crusting, redness and blurred vision can occur. Other changes to the eyes can occur, warranting specialist treatment by an ophthalmologist (eye specialist).
Rarer variants of rosacea also exist, including granulomatous rosacea and a severe form called rosacea fulminans or pyoderma faciale.
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