Stages of Rosacea

Pre-Rosacea
In general, people who are prone to frequent bouts of facial flushing and blushing are placed into this category. At this stage, facial redness from the flush is very transient and immediately disappears after the instigating trigger is over. For example, a transient flush to a warm environment, exercise, facial cleansing, overheating, or embarrassing situation, can all be categorized as pre-rosacea flushes.
Although this stage is usually quite innocent in nature, pre-rosacea flushing is the first cardinal sign of rosacea.In the pre-rosacea stage, most sufferers experience a basic functional change in the reactivity of facial blood vessels - i.e., rosacea blood vessels dilate to more stimuli, open up wider, and stay open for longer periods of time than do normal facial blood vessels. This basic difference is responsible for the frequent facial flushing. At this early stage, there are usually no signs of physical damage to the blood vessel wall.


Mild Rosacea
The mild stage of rosacea begins when the facial redness induced by flushing persists for an abnormal length of time after the instigating trigger is over -- usually a half-an-hour or more after the trigger is over. During this stage, many rosacea sufferers also report that their facial skin has a healthy-looking glow to it.
Individuals who experience frequent bouts of pre-rosacea flushing are especially susceptible to progressing into mild rosacea (the first "true" form of rosacea). In mild rosacea, facial blood vessels tend to become even more reactive - dilating more easily than in pre-rosacea. This subtle change results in greater blood flow into the superficial layers of the facial skin. Facial blood vessels also remain open for exaggerated periods of time, resulting in facial redness that persists for an extended period of time after the initial trigger is over. In mild rosacea, there may also be minor structural damage to facial blood vessels, but this is not an important factor..... At least not yet.

Moderate Rosacea
The moderate stage of rosacea begins when the facial redness persists for days or weeks - often times becoming semi-permanent in the central areas of the face such as the nose and cheeks. This results in a generalized 'sunburned' or 'windburned' look. In facial areas where chronic flushing or redness is intense, swelling and burning sensations may also occur. A significant number of patients also report outbreaks of inflammatory papules (tiny red bumps), and pustules (tiny red bumps with pus) during this stage. In most cases there are prominent areas of telangiectasia that are located in facial areas where flushing is the worst.
As facial flushing becomes more frequent and intense, blood vessels become dysfunctional and often incur significant structural damage. These vascular changes result in long-lasting facial redness, broken blood vessels, swelling, and inflammatory papules. At this stage, facial blood vessels may exhibit several different levels of structural damage:
Mild damage: Blood vessels that have mild damage can still function normally. This damage can be fixed by the blood vessel's internal repair mechanisms.
Moderate damage: Blood vessels that have received moderate damage are usually 'sick', and function much differently than normal blood vessels. This structural damage is much harder to repair, and in some cases, cannot be fully fixed.
Severe damage: Blood vessels that have incurred severe damage are permanently dilated (telangiectasia). These blood vessels cannot fix themselves. These vessels serve as open tunnels for large volumes of blood flow.

Severe Rosacea
A small portion of sufferers progress to the final stage of rosacea which is characterized by intense bouts of facial flushing, severe inflammation, swelling, facial pain, and debilitating burning sensations. On top of the inflammation can emerge crops of inflammatory papules and pustules. At this stage, some patients may also develop rhinophyma (rino-fi-ma), a bulbous enlargement of the nose.
After months, years, or decades of uncontrolled flushing and inflammation, permanent changes take place in the facial skin and blood vessels.
Major changes include:
(1) Widespread damage to facial blood vessels,
(2) Extreme hyper-reactivity of the remaining blood vessels,
(3) Significant leakage from damaged blood vessel walls,
(4) Adverse changes to facial skin.