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Pathology of Rosacea

Dr Sampurna Roy MD          




Rosacea (acne rosacea) is an inflammatory disease affecting the central part of face characterized by persistent or recurrent episodes of erythema, papules, pustules and telangiectasias.

It is a common disorder of young and middle aged adults. Children are rarely affected.

Aetiopathogenesis of rosacea is not clear.

Several hypotheses have been documented in the literature and include potential roles for vascular abnormalities, dermal matrix degeneration, environmental factors, and microorganisms such as Demodex folliculorum and Helicobacter pylori.


Commonly occurs on the center of the face ( nose, forehead, cheeks, and chin)

Gross clinical presentation: 

The lesion may present red macules, papules, and nodules, as well as pustules and telangiectases.

1. Telangiectatic: Erythematous macules associated with strikingly dilated end blood vessels.

2. Perioral-periocular dermatitis: Papules and pustules around the mouth and eyes

3. Granulomatous: Characterized by tuberculoid granuloma.

4. Rhinophyma: Enlargement of the nose due to proliferation of sebocytes in sebaceous glands.

There is formation of infundibular cysts that rupture and elicit  granulomatous and fibrosing inflammation

5. Lupus miliaris disseminatus faciei :  Papular variant of granulomatous rosacea

Visit: Granulomatous Reaction Pattern

Histopathologic features:


There is a combination of various histopathological features:

Telangiectasia of superficial blood vessels;

Perivascular infiltrates of lymphocytes (mild to moderate in intensity) and, sometimes, plasma cells ;

Active pustular lesions show superficial folliculitis;

Older lesions show granulomatous perifolliculitis.

Demodex mites are noted (20-50% cases);

Well-circumscribed collections of epithelioid histiocytes, usually in peri-infundibular location ;

Granulomas surrounded usually by lymphocytes and, sometimes, plasma cells ;

Small collections of neutrophils in some granulomas ;

Caseous necrosis may be present within some granulomas. 

Rhinophyma:  Sebaceous gland hypertrophy and scattered follicular plugging.


Differential diagnosis:

Tuberculosis and other mycobacterial infections : Tuberculoid granulomas with caseous necrosis.

The lesion is not infundibulocentric.

Bacterial infundibulitis and acne vulgaris.


Further reading

Skin microbiota: overview and role in the skin diseases acne vulgaris and rosacea.

A histological and immunohistological study of vascular and inflammatory changes in rosacea].

Role of Helicobacter pylori in common rosacea subtypes: a genotypic comparative study of Egyptian patients.

Acantholytic rosacea of the forehead and scalp in a patient with Hailey-Hailey disease].

Rosacea: I. Etiology, pathogenesis, and subtype classification.




Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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