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A 34-year-old woman with extensive papulopustular rosacea (Figures 119-1, 119-2, 119-3) has a history of easy facial flushing since her teen years. Her face has been persistently redder in the past 5 years and she is bothered by this. She acknowledges that her mom has similar redness in her face and that she is from northern European heritage. In the last 6 months, since her daughter was born, she has developed many "pimples." Physical examination reveals papules, pustules, and telangiectasias. No comedones are seen. She knows that the sun makes it worse but finds that many sunscreens are irritating to her skin. The patient is started on oral tetracycline daily and 0.75% metronidazole cream to use once daily. She agrees to wear a hat and stay out of the sun during the middle of the day. She will continue to look for a sunscreen she can tolerate. She knows that precipitating factors for her include hot and humid weather, alcohol, hot beverages, and spicy foods. She will do her best to avoid those factors.

FIGURE 119-1

Rosacea in a 34-year-old woman showing erythema, papules, and pustules covering much of the face. Note her fair skin and blue eyes from her northern European heritage. (Reproduced with permission from Richard P. Usatine, MD.)

FIGURE 119-2

Close-up of papules and pustules in the same woman. Note the absence of comedones. This is not acne. This is papulopustular rosacea. (Reproduced with permission from Richard P. Usatine, MD.)

FIGURE 119-3

Close-up showing telangiectasias on the nose and papules around the mouth and chin. (Reproduced with permission from Richard P. Usatine, MD.)


Rosacea is an inflammatory condition of the face and eyes that mostly affects adults. Most commonly the face becomes reddened over the cheeks and nose, and this is often accompanied by telangiectasias and a papulopustular eruption.


Rosacea is also called acne rosacea but is not a type of acne.


  • Common in fair-skinned people of Celtic and northern European heritage.

  • Women are more often affected than men.

  • Men are more prone to the extreme forms of hyperplasia, which causes rhinophymatous rosacea (Figures 119-4 and 119-5).

FIGURE 119-4

Rhinophymatous rosacea with skin thickening, glandular hyperplasia, and a bulbous appearance of the nose in this young Hispanic man. The cheeks and forehead also show erythema and papules. The patient acknowledges current heavy alcohol intake. (Reproduced with permission from Richard P. Usatine, MD.)


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