The pathophysiology of the vascular and inflammatory stages of facial rosacea and proposes an underlying cause is reviewed. It can be argued that all the stigmata of rosacea are manifestations of an inflammatory process: neutrophilic dermatosis. For this reason, treatments that block neutrophil involvement in the development of rosacea, such as topical metronidazole and systemic antibodies, should be considered first-line therapy for all stages of the disease.