Characteristically, flushing begins on the forehead, bridge of the nose and cheeks. The periorbital and perioral areas are generally spared. Occasionally, it tends to be more widespread affecting the neck and sometimes, may spread beyond the face and the neck areas.
Over a period of months or years, intermittent flushing is replaced by persistent erythema with papules or pustules. There are neither comedones nor seborrhoea. Soreness, burning, itching or stinging are common complaints.
Ocular involvement may occur (usually bilateral) and result in mild blepharitis and conjunctivitis. Patients may complain of a foreign body sensation(1). More seriously, there may be corneal ulceration and visual impairment. Ocular rosacea is the usual cause of posterior blepharitis.
Rhinophyma is a common complaint especially in males. The male: female ratio is approximately 20:1
The clinical features often overlap in rosacea, but in the majority of patients, a particular manifestation of rosacea dominates clinically. These can be divided into 4 subtypes:
Reference:
1. Gallo RL, Granstein RD, Kang S, et al. Standard classification and pathophysiology of rosacea: the 2017 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. 2018 Jan;78(1):148-55.
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