Four Kinds of Red in the Face

Rosacea subtypes have significantly different symptoms

/ Author:  / Reviewed by: Chris Galloway, M.D.

(RxWiki News) Redness in the face is found in all cases of rosacea. But different types of rosacea come with different markings.

A recently published study found significant differences in the symptoms of patients with basic flushed rosacea compared to patients with a kind of rosacea marked by bumps and pustules.

According to researchers, a small proportion of patients may progress from one kind of rosacea to another.

"Talk to a dermatologist about long-term redness in the face."

Researchers, led by Jerry Tan, from the Department of Medicine at the University of Western Ontario and Windsor Clinical Research Inc., in Canada, looked at four different types of rosacea.

The categories or patterns of rosacea include erythematotelangiectatic (ETR), papulopustular (PPR), phymatous (PHY) and ocular (OC).

ETR rosacea is characterized by the flushing and persistent redness in the skin. Phymatous is defined by abnormal growth of the skin, commonly around the nose.

Papulopustular includes bumps and pimples on the skin, and ocular rosacea occurs in or around the eyes with ETR or PPR present.

The study recruited 135 adult patients with rosacea in Northern Germany between January and May 2010.

Each of the patients underwent an evaluation by a dermatologist on their primary and secondary rosacea features. The dermatologist also looked for flushing, photoaging, symptoms along the eyes and other related disorders. 

Researchers tracked patients' demographic information and whether they were previously treated.

About two thirds of the patients reported flushing in their skin with 100 percent of those cases along their cheeks.

Rosacea involving abnormal skin growth was found more often with cases involving pimples and bumps than with ETR cases, researchers found.

Facial burning, stinging, fluid swelling in the body and skin swelling in the face were significantly linked with papulopustular rosacea compared to ETR rosacea.

Papulopustular rosacea was tied more often to burning, skin tension and itching during flushing episodes compared to the other rosacea types. At the same time, ETR rosacea was more frequently linked to dry facial skin.

Papulopustules, or skin lesions, cleared away in 42 percent of the patients, with 80 percent of the lesions disappearing from the cheeks and about two thirds of cases from the nose.

Among patients who had at least two subtypes of rosacea, 66 percent developed ETR before papulopustular.

Another 83 percent developed papulopustular rosacea before they developed phymatous, and 92 percent developed ETR before phymatous.

"There is no official standard or universally accepted definition of rosacea and it has been considered to be a cutaneous reaction pattern or typology with case clustering around characteristic clinical features…" researchers wrote in their report.

"While the National Rosacea Society Expert Committee diagnosis and classification system have been incorporated into basic, clinical and therapeutic investigations, information on associations between subtypes; the relative prevalence of these features among subtypes; and quantitative and qualitative aspects of these features in rosacea have been sparse," researchers wrote.

Researchers noted their findings might not reflect the rest of the population since they did not take gender differences into account.

The study, funded by ProDerm and Galderma, was published online April 21 in the British Journal of Dermatology.

Several of the authors received grants and honoraria for their work as advisors, speakers and trialists for Galderma. Another author is founder and medical director of ProDerm, which also received honoraria for performing the study.

Reviewed by: 
Review Date: 
May 2, 2013
Last Updated:
November 5, 2013