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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 skin disorder that presents with a variety of clinical manifestations primarily localized on the central face [1,2]. The disorder is divided into four main subtypes: erythematotelangiectatic, papulopustular, phymatous, and ocular rosacea.

Persistent centrofacial redness is a characteristic feature of the erythematotelangiectatic form of rosacea, while papulopustular disease presents with acne-like inflammatory papules and pustules in a similar distribution. The less common phymatous form of rosacea may demonstrate marked skin thickening and distortion of facial contours. Ocular rosacea, which often presents with eye redness, pruritus, or irritation and hordeola (styes), can occur in the presence or absence of cutaneous disease. (See "Ocular rosacea".)

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 fair-skinned individuals (skin phototypes I and II) (table 1). People of Celtic and Northern European origin appear to have the greatest risk for this disorder [3,4]. 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 [3,5,6].

Rosacea occurs in people with darker skin complexions, but is less frequently diagnosed in such populations (picture 1A-B) [7-12]. 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.


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Literature review current through: Mar 2017. | This topic last updated: Jan 23, 2017.
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