Understanding the 4 Types of Rosacea

If you suffer from rosacea — the chronic skin condition that affects 16 million Americans — you know about its characteristic flushing and breakouts. However, you may not know that rosacea has four distinct types that affect you differently.

Dr. Robert Topham and our Holladay Dermatology & Aesthetics experts help folks throughout the greater Salt Lake City area understand the unique nature of each rosacea type so we can treat it effectively. Here’s a look at the four forms of rosacea.

Rosacea 101

Rosacea primarily affects the face with redness, visible blood vessels, and sometimes painful bumps or pimples. While the exact cause is unknown, the most likely suspects are genetics, immune system issues, and environmental triggers. Recognizing the type of rosacea you have is the first step in managing it.

Type 1: vascular rosacea

You can recognize vascular rosacea, also known as erythematotelangiectatic rosacea, by its characteristic facial redness. Small blood vessels become visible, creating a flushed appearance. It’s often mistaken for blushing or sunburn, but it’s more persistent and can worsen over time.

You may also experience stinging or burning sensations. The redness can spread from your cheeks to your forehead, chin, and nose. 

To manage vascular rosacea, you have to identify and avoid triggers like spicy foods, alcohol, and extreme temperatures. 

Topical treatments such as brimonidine or oxymetazoline hydrochloride can reduce redness. 

Laser therapy, another option, targets visible blood vessels, providing more lasting results.

Type 2: inflammatory rosacea

Inflammatory rosacea, or papulopustular rosacea, includes the facial redness seen in vascular rosacea but adds another layer of complexity — red bumps and pus-filled spots. 

These can resemble acne but are not caused by the same condition. The pustules can become painful and swollen, but unlike acne, inflammatory rosacea doesn’t cause blackheads.

We typically prescribe topical and oral antibiotics, such as metronidazole cream and doxycycline, to treat inflammatory rosacea by reducing inflammation and bacterial growth. 

Type 3: phymatous rosacea

Phymatous rosacea is less common. It causes the skin to thicken and become bumpy, most often affecting the nose — a condition known as rhinophyma. It can also affect other areas like the chin, forehead, and ears.

In addition to thickened, bumpy skin, symptoms include irregular surface nodules and an enlarged, bulbous nose. Your skin may also appear oily and have large pores. 

We treat this type of rosacea with medications to reduce inflammation and prevent further thickening. 

More advanced cases may require laser resurfacing, dermabrasion, or electrosurgery to remove excess tissue and reshape the affected areas.

Type 4: ocular rosacea

Ocular rosacea inflames and irritates the eyes and eyelids. It can occur alongside other types of rosacea or independently, sometimes with no noticeable skin symptoms. 

Symptoms include red, dry, and irritated eyes and swollen eyelids. You may experience a gritty sensation, sensitivity to light, and blurry vision. In severe cases, it can lead to more serious eye conditions like keratitis.

Dr. Topham often prescribes steroid eyedrops or oral antibiotics like doxycycline to manage severe cases. Artificial tears can also help alleviate dryness and irritation.

To find out which type of rosacea you have and how to treat it, call Holladay Dermatology & Aesthetics in Holladay, Utah, to schedule an appointment with our rosacea specialists.