Rosacea is a common chronic cutaneous disease primarily of the facial skin. It is common in the third and fourth decade of life, peaking at the age of 40 and 50 years. The causes of rosacea are still not identified. Among others an important factor seems to be a microcirculatory disturbance.[see - pathophysiology of rosacea] The early stage rosacea is characterized by persistent erythema and teleangiectasia predominantly of the cheeks frequently followed by papules and papulopustules. Later, there may occur diffuse hyperplasia of connective tissue and sebaceous glands. This can cause a hypertrophy of the nose, a so called rhinophyma. Rosacea occurs in stages and may effect the eyes, most commonly resulting in blepharitis and conjunctivitis. Also other parts beside the face such as retroauricular areas, neck, chest, back and the scalp may be affected. The clinical appearance can be similar to acne, but in contrast rosacea is not a primary follicular disease.