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Diagnosis 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 photo-damaged skin become 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 go 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. Rosacea Progression: The redness begins and gradually becomes more persistent with spidery blood vessels becoming prominent on the nose and cheeks. Trauma from abrasives and peeling agents (Retin - A and all other retnoids, steroids and exfoliants including anti-aging products) easily cause more long-lasting redness. Inflammatory papules (without pus) and pustules (with pus) develop and continue to worsen. Facial pores often become larger and prominent. If there has been any sun exposure damage over the years, the skin becomes more leathery and wrinkled. Eventually, the sides of the neck as well as the area down to the center of the chest began to redden and later the ears and area behind the ears also become more red. The facial skin contours gradually become coarse and thickened. A small number of rosacea patients realize they have a more serious presentation of the disease of rosacea with the condition of nose tissue hyperplasia beginning. More Information about rosacea can be found at The International Rosacea Foundation. More Information about treating and living with rosacea can be found
at
 Visit our new blogs for the latest news about acne, cellulite, dermatitis, and rosacea. This page last updated: February 9, 2012
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