Types of rosacea: from four subtypes to phenotypes
The familiar four types of rosacea come from a 2002 US classification: type 1 is redness with visible vessels, type 2 is bumps and pustules, type 3 is thickened skin and type 4 affects the eyes. Since 2017, expert panels have recommended describing each person by the features they actually have, because many people have more than one type at once.[1][2]
Written by the Seoul Rosacea editorial team and medically reviewed by a Korean Board-Certified Dermatologist (AAD International Fellow · ASLMS member). Last reviewed: .
What are the four types of rosacea?
In 2002 the US National Rosacea Society assembled an expert committee that produced the first standard classification. It sorted rosacea into four subtypes, which most websites still call type 1 to type 4.[1]
| Common name | Medical name | Main signs |
|---|---|---|
| Type 1 | Erythematotelangiectatic (ETR) | Flushing, persistent central redness, visible small vessels, stinging |
| Type 2 | Papulopustular (PPR) | Red bumps and pustules on a red background, often with flushing |
| Type 3 | Phymatous | Thickened skin with an uneven surface, most often on the nose (rhinophyma) |
| Type 4 | Ocular | Gritty, dry, red or watery eyes and inflamed eyelid margins |
Type 1 vs type 2 rosacea: what is the difference?
Type 1 is about blood vessels: the face reddens easily, the redness lingers, and fine vessels become visible. Type 2 includes inflammatory bumps and small pus spots on the central face, often alongside persistent redness and flushing. Bumps respond mainly to creams and tablets; redness-reducing creams fade persistent redness for a few hours, and lasers and light treat both redness and visible vessels.
In practice the two often overlap. A Korean hospital reviewed 168 patients with rosacea: 96.4% met the criteria for type 1, 50.6% for type 2, 14.3% had eye involvement and 4.8% had mild thickening. Many patients therefore fitted more than one subtype at the same time.[3] A population survey in China found a similar mix: 47.6% type 1, 35.0% type 2 and 17.4% phymatous, with eye symptoms in 31.3%.[4]
Why did experts move from subtypes to phenotypes?
Subtype labels group several features together, while the phenotype approach assesses and treats each feature on its own. The global ROSacea COnsensus (ROSCO) panel of 17 dermatologists and 3 ophthalmologists noted that individual features span several subtypes, and in 2017 it agreed to diagnose and classify rosacea by phenotype.[2] The National Rosacea Society committee published a matching update the same year.[1]
Only two features are diagnostic on their own: persistent central redness that intensifies from time to time, and phymatous (thickening) changes. Flushing, visible vessels, bumps and eye signs count as major features but are not enough alone.[2] The 2019 ROSCO update added plain-language descriptions of each feature.[5]
| Feature | Category | What it looks or feels like |
|---|---|---|
| Persistent erythema | Diagnostic | Ongoing redness of the central face that flares with triggers; harder to see on darker skin |
| Phymatous changes | Diagnostic | Thickened skin from fibrosis or oil-gland overgrowth, usually on the nose |
| Flushing | Major | A temporary rise in redness with warmth, heat, burning or pain |
| Papules and pustules | Major | Red bumps and pus spots, usually on the central face |
| Telangiectases | Major | Visible vessels on the central face, not only on the sides of the nose |
| Ocular features | Major | Eyelid-margin vessels, blepharitis, conjunctivitis, keratitis |
| Burning, stinging, dryness, swelling | Minor | Symptoms that add to the burden of rosacea |
The practical gain is in treatment. Each feature has its own first-line options, several can be treated at once, and a feature that does not respond after a fair trial gets a second first-line option or an added one.[6]
Are there four stages of rosacea?
No fixed sequence exists. The four types describe patterns, not steps, and the ROSCO panel moved away from them precisely because features cross subtype lines.[2] Some changes do build up over time, though. The American Academy of Dermatology notes that thickened skin can develop when rosacea goes untreated for years (AAD, checked 18 October 2026).
Does rosacea look different on Asian or darker skin?
Melanin can hide redness and visible vessels, which leads to under-diagnosis on darker skin.[5] Burning, stinging and bumps can then be the first clues. In the Korean series, the amount of sun exposure was linked with how often and how severely type 1 features appeared, but not with the other subtypes.[3]
How is rosacea diagnosed?
Rosacea is diagnosed by looking at the skin and eyes; no blood test confirms it. A dermatologist may order tests to rule out conditions that look similar, and a skin biopsy is reserved for unusual forms such as granulomatous rosacea (AAD, checked 18 October 2026). Photos of a flare on your phone help, because the skin may be calm on the day of the visit.
What is type 1 rosacea?
Type 1, or erythematotelangiectatic rosacea, is the redness-and-vessels pattern: flushing, persistent central redness, visible fine vessels and often stinging. In the phenotype system it is described as persistent erythema plus flushing and telangiectases.
Can I have more than one type of rosacea?
Yes. In a series of 168 Korean patients, 96.4% had type 1 features and 50.6% had type 2 bumps, so many had both; 14.3% also had eye involvement.[3]
Which type of rosacea is most common?
The redness pattern (type 1). It was present in 96.4% of the Korean series and in 47.6% of people with rosacea in a Chinese population survey.[3][4]
References
Bibliographic records retrieved from PubMed (U.S. National Library of Medicine).
- Gallo RL, Granstein RD, Kang S, Mannis M, Steinhoff M, Tan J, Thiboutot D. Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. 78(1):148-155. PubMed: 29089180
- Tan J, Almeida LM, Bewley A, Cribier B, Dlova NC, Gallo R, et al. Updating the diagnosis, classification and assessment of rosacea: recommendations from the global ROSacea COnsensus (ROSCO) panel. Br J Dermatol. 176(2):431-438. PubMed: 27718519
- Bae YI, Yun SJ, Lee JB, Kim SJ, Won YH, Lee SC. Clinical evaluation of 168 korean patients with rosacea: the sun exposure correlates with the erythematotelangiectatic subtype. Ann Dermatol. 21(3):243-9. PubMed: 20523797
- Li J, Wang B, Deng Y, Shi W, Jian D, Liu F, et al. Epidemiological features of rosacea in Changsha, China: A population-based, cross-sectional study. J Dermatol. 47(5):497-502. PubMed: 32207167
- Schaller M, Almeida LMC, Bewley A, Cribier B, Del Rosso J, Dlova NC, et al. Recommendations for rosacea diagnosis, classification and management: update from the global ROSacea COnsensus 2019 panel. Br J Dermatol. 182(5):1269-1276. PubMed: 31392722
- Schaller M, Almeida LM, Bewley A, Cribier B, Dlova NC, Kautz G, et al. Rosacea treatment update: recommendations from the global ROSacea COnsensus (ROSCO) panel. Br J Dermatol. 176(2):465-471. PubMed: 27861741