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What are the different types of Rosacea?

Dr. Nancy Shannon

Medically reviewed by Dr. Nancy Shannon, MD, PhD on June 21, 2021

Rosacea is often referred to under a single name, belying the fact that there are several different types of rosacea that people can suffer from. Though rosacea is generally associated with a general reddening of parts of the face, the full range of effects can vary significantly depending on the type of rosacea in question. 

There are 4 different types of rosacea, each of which has its own set of symptoms and treatments. Knowing the differences between them can help you get a sense of what you’re in for and what you can do about it. Here are some key things to be aware of about each:

Erythematotelangiectatic rosacea (also called Type 1)

Erythematotelangiectatic (ET) rosacea is the most common subtype of rosacea as well as the one you’re likely most familiar with. The most common symptoms of ET rosacea are the “classic” symptoms of rosacea more generally: redness and flushing around the center of the face (especially cheeks and nose); skin sensitivity that can include burning, itching, and stinging; and visible blood vessels on the face. 

ET rosacea is usually progressive, meaning that its first appearances are very minor but will worsen over time without treatment. Those with a history of becoming flushed or blushing frequently are at a higher risk for ET rosacea, and the condition may first seem to be extended periods of redness, similar to being flushed. Visible blood vessels, known as telangiectasias, may start to appear over time but will generally come and go with rosacea flare-ups. If left untreated, the appearance of these blood vessels will become more prominent and perhaps permanent. 

The severity of all subtypes of rosacea is usually graded on a scale of A to C, with A representing mild cases, B representing moderate cases, and C indicating severe cases. ET rosacea of severity A usually requires no prescription treatment and may be combatted through a doctor-recommended skin care regimen or through behavioral changes, such as avoiding rosacea triggers. Severities B and C may require more intensive treatment, such as through prescription medications or laser and light therapies, in addition to continued avoidance of triggers. 

Papulopustular rosacea (Type 2)

The second type of rosacea, papulopustular rosacea, is defined primarily by its visual similarity to acne. Those who suffer from Type 2 often experience the same redness and telangiectasia associated with ET rosacea, but Type 2 flare-ups are often accompanied by red bumps and pimples that can mimic acne. 

These blemishes are not actually comedones like most acne; they’re pustules and papules. Like ET rosacea, papulopustular rosacea is often progressive: these pustules may be mild and at first, but over time they have the potential to develop deeper into the skin and become more painful. Though flare-ups are most common on the face, some people may experience them on the neck or chest as well. Of note, rosacea does not appear on the back or shoulders (areas where acne can commonly develop).

Depending on the severity, topical and oral antibiotics are common treatments for papulopustular rosacea, with stronger antibiotics reserved for more severe cases of rosacea.. As with all forms of rosacea, avoidance of triggers and sun protection are mainstays of management for papulopustular rosacea.

Phymatous rosacea (Type 3)

The defining characteristic of phymatous rosacea is the gradual thickening of afflicted areas of skin. Though the blemishes and plaques associated with papulopustular rosacea can also result in some local skin thickening, phymatous rosacea can see entire regions of facial skin become thick or bulbous over time.

Phymatous rosacea irritates the skin and causes the sebaceous glands to become agitated and swell, resulting in elevated patches of skin. This phenomenon occurs more often in men than women, and the most common site of affliction is the nose, where long-term thickening is known as rhinophyma.

Severity A cases of phymatous rosacea are indicated by large follicles in the affected areas with no noticeable thickening. Those with severity B will notice certain areas become larger and thicker, and if left untreated these areas can transition into severity C. While severities A and B are commonly treated topically, the thickening seen in cases of severity C may require physical treatments, like laser, surgical “paring” of phymatous tissue,  or even skin grafting to ameliorate. 

Ocular rosacea (Type 4)

Simply put, ocular rosacea is rosacea that affects the eyes and surrounding eyelids/eyelashes. Ocular rosacea can appear in the presence or absence of rosacea of the skin.

Ocular rosacea may be visibly present on the eyeball in the form of enlarged blood vessels, itching/burning/watering of the eyes, and/or sensation of foreign object in the eyes. Ocular rosacea may also manifest itself in and around the eyelids. Features include styes and build-up around the eyelids and eyelashes.

Severity A ocular rosacea does not affect the eye itself, instead irritating the tissue around it. Severity B can result in fewer tears being produced, causing chronic dry eyes that require treatment. Severity C, if not attended to by a medical professional, can result in permanent damage to the cornea. 

All of the subtypes and severities of rosacea can be overwhelming at first, but we’re here to help. Get in contact with a member of our medical team today to see what rosacea treatments work best for you.

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