What’s Your Rosacea Type?by Lara DeSanto Health Writer
Rosacea is a chronic skin condition that can be frustrating and embarrassing, thanks to the fact that most of the symptoms show up front and center on your face. But this condition’s symptoms can be different from person to person, which is confusing when you’re trying to get a diagnosis. Never fear: With the help of expert dermatologists, we’ve broken down the different rosacea subtypes—including symptoms and treatments—to help you figure out which one you may be dealing with. (Spoiler alert: It may be more than one!)
Yeah… It’s a mouthful. We’ll just call it ETR, and it’s the most-common rosacea type, says Daniel Bach, M.D., a dermatologist at UCLA Medical Center in Los Angeles: “This is the type that shows up as redness of the face, particularly on the cheeks and nose.” Think of it like persistent blushing. Treating ETR can be difficult, says Jessica Gandy Labadie, M.D., from Northwestern Medicine in Chicago Department of Dermatology. That’s because it doesn’t respond as well to anti-inflammatory meds. Instead, things like laser therapies, certain topicals called alpha agonists, and avoiding triggers may be more effective, she says.
After ETR, papulopustular rosacea is the second-most-common subtype, Dr. Bach says. Along with redness, it comes with small bumps on the face that can sting or burn, the National Rosacea Society says. In fact, you might mistake this type for acne—but it differs in key ways, says Dr. Labadie. “It’ll flare—people will say: ‘I usually get little pimples on my face when I eat spicy food or drink red wine.’ That would be an indication it’s rosacea,” Dr. Labadie says. Treatments include creams, cleansers, and pills that reduce inflammation.
Rhinophyma is not as common as the first two subtypes, says Dr. Bach, but it can be the most difficult to treat, and it can lead to changes in how your nose looks. It’s most common in men. “The hallmark is having a bulbous nose with very large oil glands [enlarged pores],” Dr. Bach says. Skin thickening and inflammation are key issues in this subtype: “You might not have pustules, just redder, thick skin,” Dr. Labadie says. Treatments include antibiotics to bring down inflammation and laser or other surgery to treat skin thickening; sometimes more extensive surgery is necessary to reshape the nose, Dr. Labadie says.
Another not-as-common subtype of rosacea is ocular rosacea—yep, ocular as in eyes. Unlike the other subtypes, ocular rosacea doesn’t always come with skin symptoms, Dr. Bach says. Instead, the main sign you may have this form of rosacea is a feeling of grittiness in the eyes—like there’s something stuck in there—along with redness in some cases. “This is the type that usually needs systemic treatments like oral antibiotics such as doxycycline to prevent these eye issues,” Dr. Bach says. That’s why your dermatologist will work closely with your eye doctor if you have this type of rosacea.
Granulomatous rosacea is a little different from the rest and only accounts for about 10% of rosacea cases. “It’s not one of the four major subtypes, but it’s maybe a minor subtype,” explains Dr. Labadie. “It looks like rosacea, but it’s actually a predominance of a different type of cell in the skin,” So while this type looks super similar to the first two subtypes of rosacea, when you zoom in, you’ll see granulomas—or clusters of immune cells. Despite this difference, treatments are largely the same as other subtypes, says Dr. Labadie.
Can You Have More Than One Subtype?
Another factor may make it harder to pinpoint which subtype of rosacea you have: You can have more than one. “I see rosacea more as a spectrum that can overlap,” Dr. Bach explains. “Some people can have more of one type at some points and more of another (later). It is not unusual for people to have ETR and papulopustular.” Even with the rarer subtypes, people may have one of the more common forms first—or at the same time, according to the National Rosacea Society.
Changes in the World of Rosacea
Many dermatologists talk about rosacea in terms of the subtypes we’ve explored—but it’s important to know that in 2017, the National Rosacea Society published new guidance on how to classify rosacea that focuses less on subtypes and more on phenotypes—a word that basically means any sort of observable characteristic or symptom. The main phenotypes they describe are persistent facial redness, phymatous changes (like skin thickening), papules and pustules, flushing, visible blood vessels, eye symptoms, and more. Moral of the story? Don’t get too caught up in your subtype—as Dr. Bach said: It’s possible you can have symptoms that cross into multiple types.
Treatment Can Vary by Subtype
The best treatment for your rosacea will largely depend on the subtype and symptoms you have, along with how mild or severe they are, Dr. Labadie says. “My go-to is an antibiotic topical cream. We use it as an anti-inflammatory agent. It’s a great place to start and well covered by most insurance plans,” she says. Antibiotic creams and pills help reduce inflammation in all the subtypes except for ETR—in that case, other treatments may work better. For example, says Dr. Labadie, laser therapy may reduce redness when it is caused by visible blood vessels in ER.
Why It’s Important to Understand Your Specific Rosacea
Knowing which rosacea symptoms you have—along with understanding what your primary subtype may be—can be super helpful because it can help your dermatologist figure out how best to treat you. “A lot of physicians just group all patients as one big bucket of rosacea, but it’s clear some treatments work better for some people versus others,” Dr. Bach explains. So don’t be afraid to advocate for yourself—and when in doubt, you can use the National Rosacea Society’s Physician Finder to find a local dermatologist who is well-versed in all types of rosacea and get you your best treatment.