Rosacea is a long-term inflammatory skin condition of the central face that causes flushing, lasting redness, visible small vessels and acne-like bumps. It often starts after age 30, comes in flares, and can also affect the eyes.
Key symptoms
- Flushing set off by heat, sun, spicy food, alcohol or stress
- Persistent redness of the cheeks, nose, chin and forehead
- Red bumps and pus spots, with burning or stinging skin
- Dry, gritty or irritated eyes and red eyelids
- Thickened skin of the nose in some patients
What you find on exam
- Redness of the central face that spares the area around the eyes
- Papules and pustules without blackheads or whiteheads
- Telangiectasias on the cheeks and nose
- Eyelid margin redness and crusting; check the eyes
- Thickened nose skin (rhinophyma)
Tests
- Diagnosis is clinical, based on the pattern on the face
- ANA if lupus is a concern (photosensitive rash, joint pain)
- Eye exam if eye symptoms; ophthalmology if pain or vision change
Treatment basics
- Avoid personal triggers and use daily broad-spectrum sunscreen
- Gentle cleansers and moisturizers; avoid harsh scrubs
- Topical metronidazole, azelaic acid or ivermectin for bumps
- Oral doxycycline at low dose for moderate to severe bumps
- Topical brimonidine or oxymetazoline for redness; laser for visible vessels
Red flags
- Eye pain, light sensitivity or blurred vision
- Rash with joint pain, fever or other systemic symptoms
- No response to treatment or atypical features that suggest another diagnosis
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.