Proper skin care and treatment of rosacea and peri-oral dermatitis must first begin with an understanding of each skin condition.
Rosacea is defined on the Rosacea-Ltd Glossary pages as: A chronic inflammation of the cheeks, nose, chin, forehead, or eyelids; it may cause redness, vascularity (increased prominence of the blood vessels), swelling or hyperplasia (increase in size of the tissue), or skin eruptions similar to acne. Alternative names: Acne rosacea.
There are many stages and degrees of rosacea, which can affect how the rosacea skin condition is treated and perceived by others. The National Rosacea Society now recognizes four distinct stages of rosacea:
- The earliest stage of rosacea is a pre-rosacea condition in which the rosacea sufferer is 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. Such as a transient flush to a warm environment, exercise, facial cleansing, overheating, or embarrassing situation, can all be categorized as pre-rosacea flushes.
- The second recognized stage of rosacea is mild rosacea. In the mild stages of rosacea; rosacea is seen as 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.
- Eventually this can lead into a moderate stage of 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 'wind burned' look. In facial areas where chronic flushing or redness is intense, swelling and burning sensations may also occur. A significant number of rosacea sufferers also report incidents of inflammatory papules and pustules during this stage. In most cases there are prominent areas of telangiectasia that are located in facial areas where flushing is the worst.
- For some their rosacea may never progress beyond this stage, for others can continue to worsen. For those few rosacea sufferers, rosacea may 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, a bulbous enlargement of the nose.
The National Rosacea Society recently proposed a classification of four main types of rosacea:
- Erythematotelangiectatic rosacea also described above as mild rosacea.
- Papulopustular described above as moderate rosacea.
- Ocular rosacea in which rosacea has affected the eyes causing redness, irritation and a gritty sensation.
- Phymomatous rosacea also considered as rhinophyma as mentioned above.
There are other forms and subtypes of rosacea, which are currently not recognized by the National Rosacea Society, but as any rosacea sufferer who seeks treatment for rosacea knows, these subtypes have an equal importance.
- Hard, yellow, brown, or red cutaneous papules or nodules that may be severe and lead to scarring characterize granulomatous rosacea. These lesions tend to be less inflammatory than papules and pustules and sit upon relatively normal-appearing skin. They can vary in size among patients but are monomorphic in each individual patient, and typically appear on the cheeks and periorificial areas.
- Conglobata rosacea is a disfiguring acne-like skin condition. This form of Rosacea is relatively rare and occurs mainly in females. Conglobata rosacea is generally limited to the face and mimics the appearance of severe disfiguring acne.
- Rosacea inverse, Rosacea fulminans which is also known as pyoderma faciale, is characterized by the sudden appearance of papules, pustules, and nodules, along with fluctuating and draining sinuses that may be interconnecting. The condition appears primarily in women in their 20s, and intense redness and edema also may be prominent.
- Steroid-induced rosacea eruption can occur as an inflammatory response in any patient during or after chronic corticosteroid use.
- Edematous rosacea occurs when the skin becomes thick and filled with an accumulation of the skin's own fluids.
Rosacea can occur in singularly as any of these manifestations or in any combination of the above.
Peri-oral dermatitis is seen by some as a variant of rosacea and by others as distinct and separate skin condition. Although rosacea papules may appear in the perioral area, perioral dermatitis without rosacea symptoms cannot be classified as a variant of rosacea. Perioral dermatitis is characterized by such stigmata as microvesicles, scaling, and peeling.