About Rosacea

Stages of Rosacea - Plewig and Kligman Classification of Rosacea

Stage I: The erythema may persist for hours and days, hence the old term erythema congestivum. Erythema lasting only a few minutes is not early rosacea. Telangiectases becomes progressively prominent, forming sprays on the nose, nasolabial folds, checks, and glabella. Most of these patients complain of sensitive skin that stings, burns, and itches after application of a variety of cosmetics, especially certain fragrances and sunscreens. Trauma from abrasives and peeling agents readily induces long-lasting erythema, thus the facial skin is unusually vulnerable to chemical and physical stimuli..

Stage II: Inflammatory papules and pustules crop up and persist for weeks. Some papules show a small pustule at the apex, justifying the term papulopustular. The lesions are always follicular in origin, mainly in sebaceous follicles but also in the smaller and more numerous vellus follicles. Comedones do not occur. The deeper inflammatory lesions may heal with scarring, but scars are inconspicuous and tend to be shallow. Facial pores become larger and prominent. If there has been much solar exposure over decades, the stigmata of photodamaged skin becomes superimposed, namely yellowed, leathered skin (elastosis), wrinkles and solar comedones. The papulopustular attacks becomes more and more frequent. Finally, rosacea may extend over the entire face and even spread to the scalp, especially if the patient is balding. Itchy follicular pustules of the scalp are typical. Eventually, the sides of the neck as well as the retroauricular and presternal area may be affected.

Stage III: A small proportion of patients goes on to develop more serious expressions of the disease, namely large inflammatory nodules, furunculoid infiltrations, and tissue hyperplasia. These derangements occur particularly on the cheeks and nose, less often on the chin, forehead, or ears. The facial contours gradually become coarse, thickened, and irregular. Curiously, patients may not notice these disfigurements. The deranged appearance becomes evident when photographs from previous years are reviewed. Finally, the patient shows diffusely inflamed, thickened, edematous skin with large pores, resembling the peel of an orange. These coarse features are due to extensively inflammatory infiltration, connective tissue hypertrophy, massive fibrosis and elastosis, diffuse sebaceous gland hyperplasia, and extreme enlargement of individual sebaceous glands forming dozens of yellowish unbilicated papules on the cheeks, forehead, temples, and nose. Thickened folds and ridges may create a grotesque appearance mimicking leonine facies of leprosy or leukemia. The ultimate deformity is the phymas, of which rhinophyma is the prototype. (Drs. Plewig & Kligman)

To learn more about rosacea, click on the links below.

Definition of rosacea | Who gets rosacea | Acne rosacea | Conditions that occur with rosacea | Ocular rosacea

previous / next

Good health for your skin as well as your entire body may require a permanent lifestyle change that will reward you with a longer life and more beautiful skin to wear during those extra years.

Article of the week

EARLY ONSET ROSACEA OR PRE-ROSACEA

The earliest recognizable stage of rosacea is called pre-rosacea. That blush of embarrassment that may pop up at an inopportune moment. The classic symptoms of pre-rosacea are patchy diffuse redness or flushing and inflammation, particularly on the cheeks, nose, forehead, and around the mouth. Pre-rosacea symptoms typically appear between the ages of 30 and 50 and may affect more women than men. Because the symptoms emerge slowly, rosacea may initially be mistaken for sunburn, leading to a delay in treatment.

Although rosacea may first appear as early as the teen years, rosacea most frequently begins when sufferers enter their 30s, 40s or 50s as a flushing or transient redness on the cheeks or nose, and in some cases the chin or forehead. In this earliest stage, some sufferers may report stinging or burning sensations, including the feeling of dry or tight skin.

The signs and symptoms at this stage of rosacea include frequent episodes of flushing and redness of the face and neck that come and go. Many things can trigger a flushing episode, including exposure to the sun, emotional stress, alcohol, spicy foods, exercise, cold wind, hot foods and beverages, and hot baths. What causes flushing in one person may not cause a problem in another.

Flushing usually occurs when the body becomes fatigued and/or stressed which stimulates the sympathetic nervous system. The key to this is the autonomic nervous system ( more specifically, the sympathetic postganglionic efferent nerves). Any activation of these nerves causes vasoconstriction of "body blood vessels" -- except in the "facial blush/flush areas" where it induces potent vasodilatation or flushing with the resulting "rosacea flush".

The early signs and symptoms of rosacea may also occur as a result of products used to treat other skin conditions such as acne. As adults, when we get acne we have a tendency to treat it the same way we did as teenagers – our old acne over the counter cream or lotion packed with high concentrations of benzoyl peroxide, salicylic acid and sometimes even topical vitamin A products.

As our skin ages we find that the skin doesn't respond the same way to these acne products as it did when we were younger. The result is red blotchy areas, more breakouts; the facial skin may react by becoming oilier or dryer with increased skin sensitivity. In trying to control this, we apply even more and stronger treatments to our skin, but instead of seeing an improvement; we actually see more damage and skin-related issues as the skin creates more oil to protect it from the damage and abuse of these harsh chemicals. Thus creating a vicious cycle of over-medicating the skin causing increased facial redness, clogged pores and skin irritation.

Return to home page of this Rosacea Flushing site
Return to first About Rosacea page

Return to the top of this Rosacea-Ltd III page

MORE ABOUT ROSACEA LTD III

Rosacea-Ltd III has a 120-day, 100 percent refund for any reason. Simply return the unused portion with your letter of instructions.

Bass & Boney, Inc., maintains the confidentiality of all information provided on-line.

Click here to review our privacy policy.

We continually update this site to keep you informed of the latest scientific findings about rosacea.

Return to the top of this Rosacea-Ltd III page

Order Now! $88.00 for two disks, includes shipping and handling

This page last updated: March 12, 2010