4 Rosacea Subtypes Complex Skin Disorder Eyes Symptoms Treatments

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Rosacea is a chronic complex disorder that affects about 16 million Americans. It looks like a sunburn on the face but not painful to touch. There are 4 rosacea subtypes.

Triggers such as heat and stress bring on flare ups. These redden the face and this may vary among individuals.

It may progress or lead to another one of the 4 rosacea subtypes if not treated. They may even overlap. A person may experience more than one kind at the same time.

The subtypes are: Erthemetotelangietatic rosacea (aka ETR), Papulopustular rosacea (acne), Phymatous rosacea and Ocular rosacea.

Disclaimer: This website is for informational purposes and not for diagnosis. More details.

4 Rosacea Subtypes

Erthemetotelangietatic Rosacea Symptoms

Erthemetotelangietatic rosacea (ETR) is persistent redness on your face. Capillaries can be enlarged and visible. As a result a flare up can become worse or disappear.

Symptoms of ETR:

  • Flushing and redness center of face
  • Easily seen broken blood vessels
  • Swollen skin
  • Sensitivity
  • Stinging and burning skin
  • Dry, rough and scaly skin

Without treatment your redness can become more persistent. It may extend over more of your skin. The redness may last longer even becoming permanent.

ETR can progress if not treated properly. Some may experience warmth of the affected area as well as tingling, stinging or swelling. However some even notice a very dry feeling to their skin or it appears scaly.

I have constant red cheeks along with the spider veins. Rarely, I will have a blemish or two around my nose. If I were to rub my cheeks or apply pressure as a result this becomes darker.

I feel heat in my cheeks a lot. It is like someone turning on a stove burner. So I experience an increase in heat like that flame getting higher.

When I don’t stay hydrated inside and on my skin I’m prone to dryness. The dry skin appears to be scaly or flaky as well.

Papulopustular Rosacea Symptoms

Papulopustular rosacea (acne) with this subtype there is usually large painful blemishes (whitehead/pustules). These may appear as pus filled, red and swollen bumps. Therefore blemishes occur deep in the skin usually found on your cheek, chin and forehead.

Symptoms of papulopustular:

  • Acne breakouts and extreme red skin
  • Oily skin
  • Sensitivity
  • Visible broken blood vessels
  • Raised red patches

The affected area may also burn and sting. In addition, there may be extremely oily and/or red dry patches on your skin.

Therefore red dry patches may become thick and scaly. Developing a hard, rough surface referred to as plaques.


Severe papulopustular rosacea may consist of up to 40 blemishes that take a while to heal. These could also be seen on the scalp, neck or chest . Facial redness and flushing could also be present with papulopustular.

Papulopustular are more common in adults. Unlike acne that usually begins in your teens. It basically affects middle-aged women more.

Phymatous Rosacea Symptoms

Phymatous rosacea (aka bulbous nose or rhinophyma) is rare and affects the appearance of the nose. Skin here thickens and scars causing it to look bumpy, swollen and occasionally discolored. For instance, you can Google W. C. Fields if you would like a visual.

Symptoms of phymatous:

  • Thick skin on nose
  • Bumpy skin texture
  • Large pores on nose
  • Visible broken blood vessels

With this rare subtype it’s always best to be diagnosed and treated early. That is to say, it can cause serious concerns. For example the buildup of this thick skin can block your eyes, ears and nose.

There are not only difficulties with your breathing and smelling. It also affects your being able to see and hear.

Rhinophyma or bulbous nose, in severe cases, can even cause difficulty with eating or speaking. Because of the height and weight of the excess skin on the nose can cause limitation of mobility with your mouth.

Ocular Rosacea Symptoms

Ocular rosacea this subtype can lead to persistent dry and sensitive eyes. This may also form cysts on your eyelids. The symptoms of the eyes may be more common than thought.

Symptoms may be:

  • Eyes are bloodshot and watery
  • Burning or stinging sensation in the eyes
  • Dry, itchy
  • Gritty feeling
  • Sensitivity to light
  • Cysts on eyes
  • Decrease in vision
  • Broken blood vessels on eyelids

It also can cause inflammation inside the eyes as well as on the eyelids and skin surrounding the eyes. You may have a somewhat gritty feeling like dirt irritating your eye.

Could also be blurred vision and photosensitivity (bright light). Moreover the symptoms of ocular can be simply overlooked or misdiagnosed. Because it is difficult determining the connection between your rosacea skin symptoms and eyes.

Distinguishing ocular rosacea from other eye conditions

  • Blood vessels on the eyelids and surrounding eye area seen
  • Cyst on eyes
  • Redness, itching or swelling on the skin surrounding the eyes
  • Same symptoms as other types of rosacea
4 Rosacea Subtypes
red rose bush photo by Irina Iriser from pexels

4 Rosacea Subtypes Treatments

Treating Erthemetotelangietatic Rosacea

A skincare routine with products that are fragrance-free is most important to cleanse and moisturize. In short you might even use a sensitive skin line.

Use your prescription topical medication applied as directed to affected area. Because this addresses your redness. I have been given Metronidazole gel.

Learn and note your triggers to avoid.

Always wear your sunscreen and limit sun exposure.

Above all be gentle with skin. Avoid any items that cause irritation. This could be rotating brushes for cleaning, astringents (known to have alcohol in) and exfoliates.

Makeup with green tint can be applied to correct and conceal redness.

Lastly for severe cases if your flare ups tend to be painful advanced treatment options may be recommended. Laser or light therapy may be used. This can bring it back to a more manageable state.

There have been different responses to this treatment. Some will experience long term affects while others may have benefits that are short lived. You will need to follow up with your dermatologist after all.

Treating Papulopustular Rosacea

Firstly acne treatments may be used. As long as care is taken not to strip skin of moisture and cause irritation. This may occur with stronger chemical acne treatments.

In reducing the number of bacteria causing acne on your skin your dermatologist will prescribe oral or topical antibiotics. In addition this provides anti-inflammatory effects that are quite beneficial. Antibiotics assist those having rosacea with swelling and redness that accompany this condition.

Azeliac acid has been known to be an effective treatment for acne rosacea. Often your dermatologist will have you apply this twice a day (morning and evening). There may be some tingling and burning at first.

This should decrease and go away within a week. If not contact your dermatologist.

Retinoid are also effective in treating controlled papulopustular rosacea. And are also great with evening out your skin tone.

If severe papulopustular rosacea has not responded to other treatments your dermatologist may prescribe Isotretinoin to control it. This is used as a short term solution to clear severe breakouts.

However, it is not safe for everyone with rosacea. There are side effects to consider. Your dermatologist will probably use this as a last resort.

Procedures such as laser or light therapy may be another option to improve the appearance with redness and skin inflammation. This can be done in some cases once the papulopustular flare up is under control.

Laser or light therapy treatments will help you regain a healthy looking and feeling skin appearance. Some may have scarring and discoloration due to the deep acne papules and pustules.

Treating Phymatous Rosacea

This is not similar to the other subtypes that can be treated with oral and/or topical medications. Although it is treatable phymatous most often requires surgery.

I have watched Dr. Pimple Popper (TV) remove the thickened skin layers. Phymatous affects men more than women.

Surgical treatments usually involve slowly removing and reshaping the layers of skin on the nose. This is done by using a scalpel and/or electrocautery tools. That is to say a dermatologist or plastic surgeon will perform this complex procedure.

These doctors are familiar with both the methods of removal and reshaping. They can ensure the results will look good. To prevent any progression with the condition a medication may be prescribed as short term. This may be combined with the surgical treatment.

In addition your dermatologist will work with you in creating a maintenance plan. This will help towards avoiding any future flare ups.

4 Rosacea Subtypes
red rose by Jovana Nesic from pexels

Treating Ocular Rosacea

Typically ocular rosacea is treated with oral antibiotics. To help with those uncomfortable symptoms your dermatologist may recommend additional treatments that are soothing:

  • Warm compresses
  • Using eye cleaner (saline solution)
  • Moisturizing eyes with eye drops or other topical medications

You may need to be referred to an ophthalmologist (eye specialist). This is to ensure you receive the best treatment for your ocular rosacea.

The ophthalmologist will also assist with other concerns connected to this condition such as your vision.

It is important to create a plan were you recognize your triggers. This not only helps with managing the skin condition but will help reduce the risk of an ocular flare up.

Usually, there will be a regular daily routine to care for your skin along with eye care at home. And don’t forget your follow up visits with your dermatologist and ophthalmologist.

Wrapping it up

There are 4 rosacea subtypes. Having a complete diagnosis of which subtype or subtypes you have will help in your treatment.

Currently neither of the 4 rosacea subtypes have a cure. Triggers may take some time to figure out.

It is important to note which everyday habits and routines bring on your flares. Noting what makes your rosacea worse in a journal helps, certainly being aware of these triggers will assist in preventing future redness.

It may be necessary to make possible lifestyle changes such as diet and your habits. Individuals may have different results to the same treatment or product. Knowing you are not alone and having emotional support is comforting.

For current updates on research visit the National Rosacea Society. They also accept donations.

If you have rosacea, how long have you been diagnosed? What helps your condition the most?

Header Photo red rose by Lisa Fotios from pexels

about me
Mary is the founder of All About Our Skin. Former esthetician and CPC. Enjoys researching skincare and has been studying our skin for the past fourteen years.
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