The Four Stages of Rosacea

Health Writer

After trying to manage stubborn redness or pimples on the cheeks nose and chin that is actually rosacea, many people mistakenly assume they have acne and do not seek treatment. If you are a person with fair skin, if you also easily blush, your skin type is at the greatest risk for developing rosacea.

The rosacea skin condition may gradually progress through four stages. Although there is no cure for rosacea, there are treatments that can reverse or help control the symptoms.

This explainer takes you through the four stages of rosacea and what you need to know:

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Stage one - Pre-rosacea

The main symptom of stage one rosacea is frequent flushing on the cheeks, chin, nose or forehead. A person with pre-rosacea might also experience a burning sensation (especially when cosmetics or lotions are applied to the affected areas), as well as some swelling. However, the symptoms aren’t limited to the physical. Some people who experience persistent flushing may also feel self-conscious.

During stage it may become evident that certain triggers that cause redness. Although triggers can vary, some common ones include sun exposure,  alcoholic beverages (especially red wine), spicy foods and stress.


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Stage two - Vascular rosacea

During this stage, small blood vessels on the cheeks and nose may become more visible, which may appear as thin red lines. Small bumps and pimples on the skin may also become visible. Due to the inflammatory nature of the disease, skin areas that are covered by your rosacea might appear puffy or swollen and/or may feel tender or sensitive. Commonly reported with stage 2 rosacea is that symptoms of flushing or redness on the face becomes more persistent. Some people may develop oily skin or dandruff in addition.


Image Source: Rosaceaderm

Stage three - Inflammatory rosacea

When a person’s rosacea reaches stage three,  small bumps, some of which contain pus, may appear on the face. These may be painful. Oil glands in the nose and cheeks can become enlarged and inflamed, leading to a buildup of tissue, making your nose appear bulbous. It can take years for rosacea to reach this stage.


Image Source: Virginia Eye Consultants

Stage four - Ocular rosacetage four, known as ocular rosacea, is considered a serious condition which can lead to vision loss. A person with ocular rosacea might experience eye irritation, dry eyes, burning in the eyes, sensitivity to light, conjunctivitis and vision loss. If your condition shows signs of reaching this stage, you should immediately consult an ophthalmologist.

Not everyone with rosacea advances through all the stages. Treatment, especially when started early, can help to manage and control symptoms. Known treatments for rosacea include antibiotics and topical solutions. To better assist in managing symptoms and communicating them with your doctor, it is also recommended that you keep a diary of possible triggers and flares. Making lifestyle changes to help avoid triggers can help to minimize flares.

See more helpful articles:

How to Identify Your Rosacea Triggers

Questions to Ask Your Doctor about Rosacea


All About Rosacea: National Rosacea Society

Rosacea: Overview: American Academy of Dermatology

Questions and Answers about Rosacea: National Institute of Arthritis and Musculoskeletal and Skin Diseases