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The future of rosacea treatment will depend on developing an understanding of the aetiology and pathogenesis of the various components that result in this common cutaneous disorder. Appropriate therapy can then be directed at causative factors with the objective of preventing the development of the more florid manifestations of the disease. Until that knowledge is available treatment will be directed at the different clinical features that present in rosacea patients.

Topical treatment is a cornerstone of rosacea management in all stages of the disease. Topical treatment aims to reduce signs of inflammation (redness, pustules), prevent common relapses, and avoid triggers such as skin irritation and ultraviolet (UV)-irradiation.

Rosacea is a common chronic inflammatory dermatosis affecting the central face, characterized by intermittent periods of exacerbation and remission. It affects both sexes, and it typically presents after 30 years of age [1–3]. Reported prevalence rates of rosacea range from 0.09 % to 10 % [4]. A Greek study reported a prevalence of 1.22 %, with 0.88 % prevalence for ETT and 0.34 % for PPR [3].

Rhinophyma is part of rosacea stage III or phymatous rosacea in the classifications according to Plewig and Kligman [1] and the US National Rosacea Society Expert Committee on the classification and staging of rosacea [2].

Rosacea is a chronic inflammatory condition of the central face. Its etiology is unknown. There are four acknowledged general stages of rosacea and respectively four clinical subtypes (erythematotelangiectatic, papulopustular, phy-matous and ocular, with granulomatous rosacea being a variant form). In rare cases, extrafacial rosacea may occur. Rosacea should be treated at its earliest manifestations to mitigate progression to the stages of edema and irreversible fibrosis. Currently, established therapies are vascular laser/IPL treatment or low-dose isotretinoin in erythematotelangiectatic; topical metronidazol, sodium sulfacetamide-sulfur, azelaic acid or systemic tetracyclines in papulopustular and granulomatous; oral isotretinoin and surgical correction in phymatous; and topical treatment in ocular subtype of rosacea. Rosacea is an enigmatic disease with multiple exacerbations and remissions, and treatment is directed toward symptomatic control rather than cure.

The cause of rosacea remains unknown; a multifactorial etiology is likely. Suspected etiologies include genetic predisposition, gastrointestinal diseases, vascular instability, endocrine factors (menses, pregnancy, menopause), vitamin deficiencies (particularly riboflavin), focal infections, and Demodex folliculorum mites.