Four General Phases
How Rosacea Can Progress
Rosacea has four generally recognized phases, each with its own grouping of symptoms. Although rosacea doesn’t always evolve from one phase to the other, any particular symptom may eventually become severe — which is why early diagnosis and treatment are so important.
In its earliest phase, rosacea appears as a repeated tendancy to flush (blush) anywhere on the face. The blushing is caused by the dilation of tiny blood vessels just under the skin. Gradually, the redness from the flushing becomes more persistent, particularly around the nose.
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During this phase of rosacea, the blood vessels swell and fluid leaks out of them at a greater-than-normal rate, causing the skin to look puffy and to feel warm. As the blood vessels enlarge (dilate), they can be more easily seen through the skin as small red lines. Doctors call this symptom telangiectasia, but its more common name is “spider veins.”
The skin also become more sensitive, often causing a slightly burning or stinging sensation, particularly when cosmetics or other skin products are used. And the skin’s sebaceous glands enlarge, making the skin more oily.
Inflammatory (Papulopustular) Rosacea
The development of papules (small red bumps) and postules (pus-filled pimples) is a sign that rosacea has entered the inflammatory stage. Although these symptoms resemble those of acne, the two conditions are quite different — and require different treatments.
In its most advanced phase, rosacea retains all its earlier symptoms, only they appear more intense. The redness of the skin deepens, and the number of visible veins increases.
The skin may also thicken. In some people, the excess skin tissue causes the nose to become enlarged and bulbous — a condition called rhinophyma.