About This Page
This is a clinician-written, evidence-based summary aligned to the 2026 MLA Content Map. It is intended for medical students and junior doctors preparing for the UKMLA. Always cross-reference with NICE guidance, local protocols, and clinical judgement.
Key points
- Centrofacial erythema, telangiectasia, papules/pustules — NO comedones (key distinction from acne)
- Subtypes: erythematotelangiectatic, papulopustular, phymatous (rhinophyma), ocular
- First-line: topical ivermectin 1% OD or topical metronidazole 0.75% BD
- NEVER use topical steroids — causes steroid rosacea
- Triggers: UV, alcohol, hot drinks, spicy food, temperature extremes
Overview
Rosacea is a chronic inflammatory condition of the central face involving neurovascular dysregulation, innate immune dysfunction, and Demodex mites. Characterised by flushing, erythema, telangiectasia, and inflammatory papules/pustules WITHOUT comedones. Topical corticosteroids worsen rosacea (steroid rosacea). Rhinophyma: progressive nasal thickening from sebaceous hypertrophy.
Epidemiology
Affects ~5-10% of the population. More common in fair-skinned Northern Europeans. Peak onset 30-50 years. Rhinophyma more common in men.
Clinical Features
Symptoms
Recurrent facial flushing triggered by heat, alcohol, spicy food
Persistent centrofacial erythema (nose, cheeks, chin, forehead)
Papules and pustules WITHOUT comedones
Eye symptoms: gritty, dry eyes, blepharitis (ocular rosacea)
Signs
Centrofacial erythema with telangiectasia
Papules/pustules — NO comedones
Rhinophyma: progressive nasal enlargement
Ocular: blepharitis, keratitis
Investigations
First-line
Clinical diagnosisCentrofacial erythema + papulopustules WITHOUT comedones
Specialist
OphthalmologyIf significant ocular symptoms or keratitis
Management
BAD Guidelines + NICE CKS1
General
- Avoid triggers: UV (SPF30+), alcohol, hot drinks, temperature extremes
- NEVER use topical corticosteroids — causes steroid rosacea
2
Papulopustular — topical
- Topical ivermectin 1% OD for 16 weeks (first-line)
- OR topical metronidazole 0.75% BD for 12 weeks
- OR topical azelaic acid 15% BD
3
Moderate-severe — oral
- Doxycycline 40 mg MR OD (sub-antimicrobial anti-inflammatory)
- Oral isotretinoin: specialist for refractory cases
4
Erythema/rhinophyma
- Topical brimonidine 0.33% for erythema reduction
- Vascular laser/IPL for telangiectasia
- Rhinophyma: surgical debulking (CO2 laser)
Complications
- Rhinophyma: Progressive — requires surgery
- Ocular: Keratitis can threaten vision
- Steroid rosacea: Iatrogenic worsening
UKMLA Exam Tips
- 1ROSACEA: NO comedones. ACNE: HAS comedones — KEY distinction
- 2Topical steroids WORSEN rosacea — classic iatrogenic problem
- 3Rhinophyma is NOT caused by alcohol (common myth)
- 4Doxycycline 40 mg MR: sub-antimicrobial dose, no resistance
- 5Topical ivermectin: kills Demodex mites implicated in pathogenesis
Put your reading into practice
Checking available topic practice…
Choose UKMLA questions from the existing bank. General exam practice covers your selected topics; it is not filtered to this article. Your usual question-bank access applies.
Choose UKMLA practiceAfter your session, return to this section to revisit the reading and choose your next review.
regional clinical guidance
Rosacea: guidance by region
Recommendations, thresholds and pathways can differ. Open the page written for the jurisdiction you need.
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