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This chapter is set out as follows: Aetiology History Clinical findings Images Management Other resources Aetiology While rosacea is more common in patients with fair skin and blue eyes , the cause is largely unknown, although chronic vasodilatation (perhaps due to a primary error in vascular control) appears to be a factor History Age Affects adults and older patients It has a bi-modal prevalence of 20 to 30 years of age with a larger peak at 40 to 50 years Aggravating factors ​Anything that predisposes to flushing eg sunlight, caffeine, alcohol, spicy food Drugs that cause vasodilatation Topical steroids Symptoms ​ The onset of rosacea is often preceded by a history of episodic flushing The erythema associated with rosacea if often described as burning or stinging Clinical findings Rosacea Distribution ​ The central face (forehead, nose, cheeks and chin) with sparing of peri-oral and peri-orbital skin Morphology Erythema - initially intermittent but becomes more permanent Telangiectasia Papules and pustules Absence of open comedones (blackheads), unlike in acne vulgaris Thickening of the skin can occur as the condition becomes chronic A rhinopyhma , representing marked thickening of the nasal skin, effects some patients with rosacea and can cause serious disfigurement Ocular involvement ​ Occurs in over 50% of patients Can cause gritty eyes, conjunctivitis, blepharitis, episcleritis and chalazion