Papulopustular rosacea is the form of rosacea that our patient had, and is known as classic rosacea or pink papular rosacea. It is characterized by persistent erythema in the central portion of the face with persistent or episodic papules and/or pustules. These inflammatory papules and pustules may also occur in the perioral, perinasal, or periocular areas.5 Edema may accompany inflammatory episodes, but is frequently subtle.9
This subtype may be confused with acne vulgaris. The key to differentiation is looking for comedones; they are present in acne vulgaris, but absent in papulopustular rosacea. However, both rosacea and acne may be present in the same patient, making diagnosis and treatment more difficult.
Phymatous rosacea usually involves the nose (rhinophyma), but can also affect the forehead, chin, cheeks, and ears. The distinct appearance of this subtype comes from enlargement, thickened skin, and irregular surface nodularities.5 Historically, rhinophyma has been associated with alcoholism, but there is no clear evidence of this association.10
Ocular rosacea affects the eyelids, conjunctiva, and cornea. Consider this diagnosis when there is 1 of more of the following findings: foreign body sensation, burning or stinging, dryness, itching, photosensitivity, blurred vision, conjunctival telangiectases, or periorbital edema.5
Corneal involvement can threaten sight, and up to 58% of rosacea patients may experience ocular manifestations.11 Therefore, it is imperative that you ask patients with rosacea if they’ve had any problems with their eyes, and that you examine the conjunctivae and eyelids.