Types of Rosacea Explained

By Dr Magnus Lynch
MA(Cantab) DPhil(Oxon) MRCS FRCP
Consultant Dermatologist & Dermatological Surgeon
Last updated 2024-04-05

Rosacea can be classified into four main subtypes, however there is a lot of overlap and you can suffer form more than one subtype at the same time. Nevertheless, ientifying your primary subtype can help in tailoring the most effective treatment plan.

How do I know which subtype I have?

The subtypes are identified by their primary symptoms.

• Erythematotelangiectatic Rosacea: Characterised by persistent facial redness, flushing, and visible tiny blood vessels.
• Papulopustular Rosacea: Involves red bumps (papules) and pus-filled spots (pustules), often mistaken for acne.
• Phymatous Rosacea: A less common subtype causing skin to thicken and enlarge, most commonly on the nose (rhinophyma) and/or the cheeks.
• Ocular Rosacea: Affects the eyes, causing redness, dryness, burning, stinging, and swollen eyelids. For more on this, see Blepharitis, Styes and Ocular Rosacea.

Does the type change which treatments work?

Yes, absolutely. Treatment is targeted to the specific symptoms of your subtype. For erythrotelangiectactic rosacea, lasers like VBeam or IPL are effective for redness and vessels. For papulopustular rosacea topical treatments (like ivermectin or azelaic acid) and oral antibiotics are the mainstay. Phymatous changes may require procedural intervention like laser resurfacing or surgery, while ocular rosacea is managed with eyelid hygiene, artificial tears, and sometimes oral antibiotics.

How can I help

I see patients in person in central London. An in person consultation allows me to examine the skin directly including features that are difficult to capture in a photograph such as 3-dimensional changes and textural change. This is the better option where the diagnosis is uncertain, where previous treatment has not been effective, or where a procedure is being considered. For more straightforward conditions such as acne and rosacea a remote consultation with clear photographs can be a good option.

Related articles

• Do I Really Have Rosacea?
• Prescription Creams for Rosacea
• IPL vs VBeam (PDL) for Redness and Veins
• Blepharitis, Styes and Ocular Rosacea

About Dr Magnus Lynch

MA(Cantab) DPhil(Oxon) MRCS FRCP

I am a London-based Consultant Dermatologist and Dermatological Surgeon. I am highly experienced in skin cancer diagnosis, Mohs micrographic surgery, acne, rosacea, acne scarring and laser treatments. I studied at the Universities of Cambridge and Oxford, and completed my dermatology training and Mohs fellowship at the prestigious St John's Institute of Dermatology. I graduated from medical school in 2003 and have worked exclusively in Dermatology since 2012.

I lead a research team at King's College London investigating the molecular biology of skin cancer. In recent years I have been involved in Media Appearances, including the Channel 5 series 'Skin A&E', where I perform skin surgeries and treat various skin conditions.

My NHS practice is at Guy's Hospital. I consult with private patients at OneWelbeck (near to Bond Street station) and on Harley Street. Book A Consultation.