Understanding Rosacea Papules

Rosacea Papules are a small, red solid elevated inflammatory skin lesion without pus that is minor when the size is of a small measles lesion, moderate when about the size of a pencil eraser and severe when the papule is the size of a small currency coin or the tip of the little finger. The top of the papule may be flat, pointed, or rounded. Rosacea papules should not be mistaken for acne papules, which are common lesions in acne. Rosacea papules do not contain pus, while acne papules do contain pus.

Rosacea papules are small, red solid elevated inflammatory skin lesions without pus that are considered minor when the size of a small measles lesion, moderate when smaller than the size of a pencil eraser, and severe when the rosacea papule is the size of a small currency coin. Rosacea papules may open when scratched, becoming crusty and infected. A group of very small rosacea papules and microcomedones may be almost invisible but have a sandpaper feel to the touch.

Vascular flushing is a primary cause of rosacea papules. Over time, flushing results in leakage of inflammatory cells out of the blood vessels and into the skin. These inflammatory cells then migrate toward the surface of the skin, resulting in inflammatory papules. Bacteria or demodex mites do not cause facial papules.

Usually observed in stage two rosacea, inflammatory papules may crop up and persist for weeks. Rosacea papules show a small pustule at the apex, justifying the term papulopustular. The lesions are always follicular in origin, mainly in sebaceous follicles but also in the smaller and more numerous vellus follicles. Comedones do not occur. The deeper inflammatory lesions may heal with scarring, but scars are inconspicuous and tend to be shallow. Facial pores become larger and prominent. If there has been much solar exposure over decades, one may observe the appearance of photo-damaged skin in a yellowed, leathered skin (elastosis), wrinkles and solar comedones. The papulopustular attacks becomes more and more frequent. Finally, rosacea may extend over the entire face and even spread to the scalp, especially if the patient is balding. Itchy follicular papules of the scalp are typical. Eventually, the sides of the neck as well may be affected.