GPAtlas🧭 When to suspect
Rosacea is a common, chronic and fluctuating inflammatory condition of the central face – cheeks, nose, forehead and chin – typically presenting in adults aged 30–60 and most often in fair (Celtic or Northern European) skin, though it is under-recognised in skin of colour. The diagnosis is clinical, made from the pattern of features rather than any test.
The single most useful discriminator from acne is the absence of comedones (blackheads and whiteheads). Features cluster into four overlapping subtypes, and identifying the predominant one matters because each responds to different treatment. Ocular involvement is common and easily missed, so ask about the eyes in every case.
| Subtype | Key features |
|---|---|
| Erythematotelangiectatic | Persistent central facial erythema, frequent flushing and telangiectasia. Does not respond to antibiotics. |
| Papulopustular | Inflammatory papules and pustules on a background of erythema, with no comedones. |
| Phymatous | Skin thickening, patulous follicles and irregular nodularity, most often the nose (rhinophyma). Does not respond to antibiotics. |
| Ocular | Grittiness, burning, dryness, redness, blepharitis or recurrent styes/chalazia. Keratitis is sight-threatening. |
Source: British Association of Dermatologists · DermNet
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