Frequency of Rosacea Subtypes

Portrait of a young pretty Caucasian woman who frowns and shows reddened and inflamed cheeks. Beige background. Copy space. The concept of rosacea, healthcare and couperose.
Researchers sought to determine the frequency of 4 rosacea subtypes.

Of the 4 major subtypes of rosacea, erythematotelangiectatic rosacea and papulopustular rosacea are most common, according to study findings published in The Journal of the American Medical Association Dermatology.

Although no longer used, in 2002, the National Rosacea Society classified rosacea according to 4 subtypes: erythematotelangiectatic rosacea (ETR), papulopustularrosacea (PPR), phymatous rosacea (PhR), and ocular rosacea. In 2017, this categorization was replaced with a phenotype-based diagnostic approach. Researchers sought to discover the frequency of these 4 major rosacea subtypes.

To accomplish this, they conducted a systematic review and meta-analysis of 9190 patients in 39 original studies (20 cross-sectional studies, 16 case-control studies, 3 cohort studies) with sample sizes of 25 or more patients that recorded all 4 rosacea subtypes in the PubMed and Embase databases through the beginning of November, 2021.

Men were more typically diagnosed with PhR, and the other 3 subtypes were equally distributed (this analysis based on a small percentage of the 39 studies). The lowest percentage of ETR was found in studies from Africa. The investigators explained that it is possible for 1 patient to concurrently have multiple rosacea subtypes, causing the pooled frequencies in the 9190 patients to exceed 100% (ETR 56.7% [95% CI, 51.4%-62.0%]; PPR 43.2% [95% CI, 38.8%-47.6%]; PhR 7.4% [95% CI, 6.1%-8.9%]; ocular rosacea 11.1% [95% CI, 6.7%-16.3%]).

When these numbers are re-examined by study-population type (general [2] vs clinical [37]) ETR was noticeably more common in the general population (75.8%; 95% CI, 58.8%-89.4% vs 54.7%; 95% CI, 49.3%-60.0%), and there was a considerably lower occurrence of PPR in the general population (22.3%; 95% CI, 9.7%-38.2% vs 44.5%; 95% CI, 40.1%-48.9%).

Study limitations included the inconsistency of rosacea classification and the lack of ophthalmologic verification of ocular rosacea. In addition, the overwhelming majority of studies were from Europe and Asia, and not stratified by race, ethnicity, skin type, or disease severity. According to researchers, “We observed very high study heterogeneity, and the estimates generated from the meta-analysis may therefore be inaccurate.”

Researchers concluded that, “Erythematotelangiectatic and papulopustular rosacea were the most prevalent subtypes, but data should be interpreted with caution. Future studies should use the phenotype-based rosacea approach.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Barakji YA, Rønnstad ATM, Christensen MO, et al. Assessment of frequency of rosacea subtypes in patients with rosacea: A systematic review and meta-analysis. JAMA Dermatol. Published online April 6, 2022. doi:10.1001/jamadermatol.2022.0526