The Four Types Of Rosacea

Rosacea is a non-contagious, treatable condition often characterized by inflammation and reddening of the face that is most commonly seen on the skin. Rosacea can be categorized into four different types: Erythematotelangiectatic (ETR), Papulopustular, Phymatous, and Ocular. Each subtype contains its own group of symptoms that allows it to be distinguished from the rest.

The Four Types of Rosacea

Rosacea exists on a spectrum, with specific symptoms varying depending on the subtype. That’s why classifying Rosacea into 4 different categories allows for a better understanding and treatment of the condition.

Type 1: Erythematotelangiectatic Rosacea (ETR)

Type 1 is the most common type of Rosacea and is categorized by erythema (skin redness), flushing, and telangiectasia (spider veins). All of these symptoms are caused by an increase in blood flow to the facial region.

• Erythema is simply the term for any reddening of the skin and can be triggered by factors such as sunlight, alcohol, and stress.
• Facial flushing consists of skin redness, but what distinguishes flushing from erythema is the feeling of warmth in addition to the visible reddening of the skin. Flushing is short-lived in nature, as it has a rapid on and offset. Both of these symptoms are caused by an increased blood flow to the face.
• Telangiectasia, another common symptom of ETR also known as ‘spider veins’, is a condition where small blood vessels are visible on the skin.
• Type 1 rosacea is most often accompanied by a burning or stinging sensation as well.

Although these symptoms are usually harmless, they may affect self-esteem. Thankfully, type 1 rosacea is treatable with topical medications such as creams, gels, and lotions.

Type 2: Inflammatory Rosacea (Papulopustular)

Type 2 Rosacea is distinguished by papules (red bumps), pustules (pus-filled spots), and reddening of the skin.

• Papules are red bumps on the skin that are not filled with any fluid.
• Pustules are bumps filled with pus. These bumps can resemble acne, but they are not considered acne because the condition is not caused by the production of excess oil on the skin.
• Type 2 rosacea can also be accompanied by burning and stinging.

Type 2 rosacea is treatable with topical and oral medications. Although topical medication is usually used as a treatment, low doses of oral medication are sometimes taken simultaneously to increase the effectiveness of the topical treatment.

Type 3: Phymatous Rosacea

Type 3 Rosacea symptoms involve the thickening of the skin on the face. Gnathophyma, Rhinophyma, and Metophyma are the terms that describe the thickening of the skin on different parts of the face.

• Gnathophyma describes thickening of the chin.
• Metophyma describes the thickening of the forehead.
• Rhinophyma describes thickening of the nose.
• Thickening of the skin can also be seen in other areas, such as the skin on the cheeks and/or ears.

Thickening of the skin on the nose (Rhinophyma) is the most commonly seen symptom of Type 3 rosacea. Some treatments include the use of lasers, which are used to remove excess tissue. Oral medications, such as isotretinoin, can be used on their own or combined with other treatments.

Type 4: Ocular Rosacea

Unlike all of the other types of rosacea, which affect the skin, ocular rosacea affects the eyes.

• People with ocular rosacea may complain that their eyes feel dry or that their eyes are constantly watering.
• The appearance of a person’s eye may be red and visibly irritated.
• Some people may feel their vision is blurry.
• Ocular rosacea can also manifest on the eyelids as inflammation or cysts. Inflammation of the eyelids is called blepharitis, which is commonly seen on patients with dry eye symptoms.

Ocular rosacea is usually treated with artificial tears, extra eyelid care, and some oral medications. Oral medications include tetracycline and ciclosporin in more extreme cases.

References

• InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Rosacea: Overview. 2006 Feb 14 [Updated 2018 Sep 20]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279476/.
• Rivero AL, Whitfeld M. An update on the treatment of rosacea. Aust Prescr. 2018;41(1):20-24. doi:10.18773/austprescr.2018.004. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5828925/.
• Types of Rosacea. Patient Care at NYU Langone Health. https://nyulangone.org/conditions/rosacea/types.
• Weinkle AP, Doktor V, Emer J. Update on the management of rosacea. Clin Cosmet Investig Dermatol. 2015;8:159-177. Published 2015 Apr 7. doi:10.2147/CCID.S58940 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396587/.

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Brandon Kirsch, MD

Brandon Kirsch, MD, FAAD, is a board-certified dermatologist specializing in clinical drug development and medical innovation. He is the founder of Kirsch Dermatology in Naples, Florida and is also the Chief of Dermatology at the Naples Community Hospital.