Rosacea often begins with easy blushing and flushing of the facial skin. These symptoms may come and go at first. Eventually, redness persists around the nose, extending to the rest of the face. As rosacea progresses, additional facial symptoms such as burning, stinging, pimples, swelling, dry skin, enlarged blood vessels, and eye involvement may occur. These combinations of symptoms fall into the following four subtypes:
- Subtype 1: Facial Redness (Erythematotelangietatic rosacea). Flushing and/or continuous facial redness occurs. Blood vessels are visible, especially around the nose.
- Subtype 2: Bumps and pimples (Papulopustular rosacea). Pimples occur, and puslike lesions may be present, along with the facial redness. You may feel burning and stinging, and blood vessels on your face may be enlarged. This stage of rosacea is also known as acne rosacea.
- Subtype 3: Enlargement of the nose (Phymatous rosacea). Your skin begins to thicken and develops an irregular texture. This thickening is most evident on the nose and can also occur on the ears, chin, cheeks, and forehead. You may have enlarged skin pores in addition to the large blood vessels.
- Subtype 4: Eye irritation (Ocular rosacea). One or both eyes are affected in this subtype. They may be bloodshot, teary, itchy, dry, burning, or stinging, and you may have blurred or decreased vision. It's common to feel as though you have a foreign body in the eye. This is a serious eye condition; you may need to see an ophthalmologist.
Symptoms of the first three subtypes may also be present on the neck, chest, ears, and scalp. Your health care provider can evaluate the subtype of rosacea you have. He or she will prescribe the treatment based on the subtype and additional information provided during an examination.