It typically begins as redness on the cheeks, nose, chin or forehead that may come and go. Over time, the redness tends to become more persistent, skin swelling and visible tiny blood vessels appear and small bumps often develop. In some patients the eyes are also affected and may be watery or bloodshot, and even cause gritty discomfort.

Rosacea is characterized by flare-ups and remissions. In long standing and severe cases the nose may grow swollen and lumpy from excessive tissue (rhinophyma).

There are 4 types of rosacea, and patients may experience characteristics of more than one type at the same time.

Erythemato-telangiectatic rosacea - characterized by flushing and persistent redness, with multiple visible tiny blood vessels.

Papulopustular rosacea- characterized by persistent redness with transient bumps and pimples.

Phymatous rosacea- characterized by skin thickening, often resulting in an enlargement of the nose from excessive tissue buildup.

Ocular rosacea- characterized by dry eyes, tearing and burning, swollen eyelids, and potential vision loss from corneal damage. Referral to the ophthalmologist may be required for severe cases.

Patients with mild rosacea usually respond well to topical treatments. These include antibiotics (metronidazole and clindamycin gel and lotions) and vitamin A derived creams or gels (adapalene and tretinoin).

In more severe cases, a course of oral antibiotics (usually doxycycline or erythromycin) may be prescribed to control symptoms. These oral antibiotics may exert an anti-inflammatory effect and are usually taken for several months. However, repeated courses may be necessary for patients with frequent recurrences.

In patients unresponsive to oral antibiotics, oral isotretinoin may be prescribed with good result. Adverse effects of isotretinoin include dry lips and skin, muscle aches, hair loss, abnormal liver function tests and raised lipids, muscle inflammation and depression. Female patients should not become pregnant while on therapy as it can affect the developing fetus.

The Pulsed Dye Laser machine can be useful in reducing persistent redness and treating the prominent blood vessels of rosacea. For patients with an enlarged swollen nose (rhinophyma), the Carbon Dioxide Laser can be used to reduce the thickness of the skin