Acne and Rosacea Charity Training Manual

Types of Rosacea
National Rosacea Society Expert Committee on the Classification and Staging of Rosacea 2004 has reclassified rosacea
into 4 types. In some ways, this is a rather artificial grouping as phytomatous change and ocular involvement are really
sequelae of rosacea rather than being individual entities:
Type I
Erythematotelangiectatic rosacea. In my practice this is the most common form. In some patients it may
progress to Type II, Papulopustular rosacea but it may only manifests as vascular response. Flushing
may be spontaneous or may be precipitated by a trigger factor. The flushing, unlike physiological
flushing, lasts more than 10 minutes and can last hours or days. It may be asymptomatic or cause a
burning sensation or even pain, which may be severe. Trigger factors are very individual to the patient.
Never impose an exclusion diet without first ascertaining what triggers flushing in that patient. In a large
survey conducted in USA the commonest trigger factor was sun exposure, but I have patients who
improve with a sunny holiday. I have patients who can eat a Vindaloo curry but spring onions will cause
a flush and I have patients who can drink beer or white wine but not red wine or spirits. Get your patient
to keep a diary and if they identify something that triggers a flush, try to avoid it.
Type 1 Rosacea in a 22 year old woman
Type II
Papulopustular rosacea. This occurs following a period of flushing or concurrent with flushing. The spots
look like acne which is why rosacea was previously, erroneously called acne rosacea, but in pure rosacea
there are no comedones and the spots may be follicular or interfollicular. Spots may be of any severity and
may become nodulocystic.
Type 2 Rosacea in a 35 year old man