Erythrotelangiectatic rosacea (rosacea subtype 1) may be the initial phase of rosacea for many people. Patients are red, flush easily from various stimuli such as alcohol, caffeine or temperature changes. Sun protection is key to prevent long term progression of this stage, which may progress. Coverup makeups can be used, and the newer mineral makeups seem to work well and are non-irritating.
For rosacea subtype 1, the best treatment is the Pulsed Dye Laser (PDL) or intense pulsed light (IPL). These lasers and light sources target the blood vessels that are the cause of this condition. Generally 3-4 treatments are sufficient for excellent results.
Most of the prescription medications for rosacea target papulopustular rosacea (rosacea subtype 2). Topical medications (metronidazole and azelaic acid) and oral medicines, such as doxcycycline (Oracea) and minocycline, are very effective in decreasing the red pimples and bumps.
Long-term use of rosacea medications is the rule, and flares tend to recur as rosacea medications are weaned. Pulsed dye laser treatment may improve rosacea subtype 2 symptoms and decrease the frequency of flares.
Rhinophyma, seen with rosacea subtype 3, generally only occurs with men and less commonly than a few generations ago.
Treatment of rhinophyma can be with ablative lasers such as the CO2 laser, or with an electrocautery unit. Many patients find improvement in their sleep and less snoring, as well as a improved cosmetic appearance, with treatment.