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Rosacea: Pathogenesis, clinical features, and diagnosis

Mark V Dahl, MD
Section Editor
Robert P Dellavalle, MD, PhD, MSPH
Deputy Editor
Abena O Ofori, MD


Rosacea is a common, chronic disorder that can present with a variety of cutaneous or ocular manifestations. Skin involvement primarily affects the central face, with findings such as persistent centrofacial redness, papules, pustules, flushing, telangiectasia, and phymatous skin changes (eg, rhinophyma). Ocular involvement may also occur, manifesting with lid margin telangiectases, conjunctival injection, ocular irritation, or other signs and symptoms.  

The pathogenesis, clinical manifestations, and diagnosis of rosacea will be reviewed here. The treatment of rosacea is discussed separately. (See "Management of rosacea".)


Rosacea is a common disorder that is most frequently observed in individuals with lightly pigmented skin (skin phototypes I and II (table 1)). People of Celtic and Northern European origin appear to have the greatest risk for this disorder [1,2]. The prevalence of rosacea is difficult to assess due to its variable clinical manifestations and the wide variety of skin disorders that exhibit similar clinical features (see 'Differential diagnosis' below). Estimates of the prevalence of rosacea in fair-skinned populations range from 1 to 10 percent [1,3,4].

Rosacea occurs in people with greater skin pigmentation but is less frequently diagnosed in such populations (picture 1A-B) [5-10]. It is unknown whether factors such as masking of facial redness by abundant skin pigment, protective effects of melanin against ultraviolet radiation (an exacerbating factor for rosacea), or genetic differences in susceptibility to rosacea contribute to the lower rate of diagnosis in people with dark skin.

Adults over the age of 30 are the primary age group affected by rosacea, and the disorder occurs more frequently in women than in men [1,11]. Patients with phymatous skin changes are an exception; the vast majority of affected patients are adult males (picture 2). Rosacea occasionally occurs in adolescents. In this population, rosacea is often mistaken for acne vulgaris. Rarely, rosacea occurs in children. Children may exhibit all subtypes except phymatous changes, and symptoms may persist into adulthood [12-14].

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Literature review current through: Nov 2017. | This topic last updated: Nov 21, 2017.
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