In 2004 in an article appearing in the Journal of the American Academy of Dermatology, Crawford et al. proposed the concept of glandular rosacea to describe another phenotype distinct from the four subtypes introduced by the expert committee. Glandular rosacea occurs predominantly in males who characteristically have oily skin, large pores, a tendency to rhinophyma, and inflammatory lesions, including papules, pustules and nodulocystic lesions, that extend onto the lateral cheeks and neck.

"It is good to remember there are patients with rosacea who have acne-like lesions that are not just centrofacial, and that points attention to the questions about potential relationships between acne vulgaris and rosacea," Dr. Powell says.

Debate also continues over whether rosacea conglobata and rosacea fulminans are variants of acne vulgaris or rosacea.

Dr. Powell also cites a study published by Gupta et al. in 2005 to remind his colleagues that rosacea can have a devastating quality of life impact. That study included thousands of subjects, and it found patients with rosacea had a 4.8-fold increased risk for depression. No association was found between alcohol abuse/dependence and rosacea.

"In treating patients with rosacea, we are well aware of the psychological effects of this disease, and the depression, anxiety and social isolation it can cause," Dr. Powell says.

"The myth of alcohol abuse causing the redness of rosacea is further debunked by this study," he adds.