1. Frequent Facial Flushing:
Facial flushing is the classic symptom of rosacea. In all simplicity, flushing is the result of increased blood flow through dilated facial blood vessels. During a flush, a rosacea sufferer's face can turn various shades of red depending on the amount of blood flowing through the skin. A sufferer may experience a fire-red face during intense flushes, a mildly-red face during moderate flushes, or a barely noticeable pinkish-hue during mild flushes. Depending on the stage of rosacea, a facial flush can be transient (lasting only for seconds), or long-standing (lasting for days, weeks or months).

2.  Facial Redness:
Facial redness is one of the most common symptoms of rosacea. This is caused by hundreds of tiny dilated blood vessels near the surface of the facial skin.

3.  Facial Telangiectasia (tel-an-jek-tasia):
These are tiny broken blood vessels that are permanently fixed in the dilated state. These blood vessels take on the appearance of fine red lines coursing through the surface of the facial skin.

4.  Facial Skin Hyper-Reactivity:
Facial skin hyper-reactivity is caused by sensitive, inflamed blood vessels near the surface of the skin. These blood vessels dilate very easily to topical triggers and physical insults. It is important to note that the term 'sensitive skin' is misleading to rosacea sufferers because the problem is based on sensitive blood vessels, and not sensitive skin cells.

5.  Lumpy-Bumpy Facial Skin:
Uneven skin texture, or lumpy-bumpy facial skin is caused by dilated blood vessels, localized swelling, mild fibrosis, and leakage of inflammatory cells into the superficial layers of the skin.

6.  Facial Papules:
Facial papules are small, red bumps about the size of a pinhead. These bumps are caused by vascular flushing. Over time, flushing results in leakage of inflammatory cells out of the blood vessels and into the dermal skin. These inflammatory cells then migrate towards the surface of the skin, resulting in the inflammatory papules. Facial papules are not caused by bacteria or demodex mites.

7.  Facial Pustules:
Facial pustules are small red bumps with pus. These bumps are caused by vascular flushing in areas around sebaceous glands. Over time, flushing results in leakage of inflammatory cells out of the blood vessels and into the dermal skin. These inflammatory cells then migrate towards the sebaceous gland or pore, resulting in inflammatory pustules.

8.   Facial Burning Sensations:
Facial burning sensations are caused by activation of sensory pain nerves in the facial skin. These pain fibers are primarily triggered by the heat associated with increased blood flow. These nerve endings can also be activated by inflammatory substances that leak through blood vessels. After chronic activation, pain nerve fibers may become sensitized to other triggers such as skincare products and environmental insults (i.e., sun, wind, heat, and cold). Facial burning sensations can become severe in some sufferers, causing debilitation.

9.  Facial Swelling:
Facial swelling occurs when fluid and proteins leak out of facial blood vessels at abnormal rates. Frequent facial flushing leads to increased movement of water and proteins across abnormal blood vessel walls. Over time, this "spillage" overwhelms the lymphatic system (drainage vessels), and leads to fluid build up in the facial skin.

10.  Rhinophyma:
Rhinophyma is a form of rosacea that is characterized by chronic redness, inflammation, and increased tissue growth of the nose. Rhinophyma can take on many different forms. In most forms, the nose is chronically red and inflamed. There is also evidence of swelling, and the skin often shows thickened skin with large pores, resembling the peel of an orange (peau d'orange). In some forms, sebaceous gland hypertrophy and hyperplasia (increased growth and number of sebaceous glands) can cause the nose to grow considerably, resulting in a bulbous appearance.

11.  Ocular Symptoms:
More than half the rosacea sufferers that present with facial symptoms also have ocular rosacea.  Ocular rosacea is primarily vascular in origin, but secondary causes may exacerbate the condition.  Symptoms include inflammation of the eye surface, inflammation of the eye lids, scales or crusting on eye lids and eye lashes, blockage of the meibomian glands (blepharitis), dry eye syndrome, excessive tearing and blood shot eyes.

Rosacea Flushing Triggers

Rosacea sufferers are instructed to stay away from all their flushing triggers. Sadly, general physicians dont understand the impact that this recommendation has on the quality of life of their patients.  As profiled in the list below the avoidance of rosacea triggers is a trigger in and of its self.  "Avoiding triggers is like trying to dodge raindrops in a monsoon."

What the average physician does not understand is that this may lead to major life style changes, alter relationships, cause seclusion and lead to depression in many patients.

We do not feel that avoidance of triggers is an acceptable form of treatment.

Below is a common list of triggers that rosacea sufferers have to deal with :

Emotional Triggers:

Anxiety
Concentration
Crying
Embarrassment
Excitement
Intimacy
Laughing
Stress

Environmental Triggers:

Cold Climates
Heat ( > 85° F )
Warm ( > 70° F )
Sun
Wind

Hormonal Triggers:

Birth Control Pills
Estrogen
Perimenopause
Premenstrual
Postmenopause

Ingested Triggers:

Foods:

Large Meals
Spicy Foods
Hot Foods

Beverages:

Alcohol
Hot Beverages

Physical Triggers:

Exertion, Light
Exertion, Heavy
Lying Down
Migraines
Overheating
Pain
Sleeping

Topical Triggers:

Alcohol Containing
Cleansers
Exfoliants
Moisturizers
Sunscreens
Toners

Other Triggers:

Spontaneous
Fluorescent Lighting
Computers

The Progression of Rosacea

In the beginning rosacea symptoms usually starts out quite innocently as a mild flush across the nose, cheeks, chin, and forehead.

The Early Stages of Rosacea -- Mild Rosacea Symptoms May Include:

• Facial flushing comes and goes
• Sensitivity to topical products
• Burning or stinging sensations
• Facial redness triggered by environmental  insults, hot beverages, spicy foods and alcohol

As rosacea progresses -- Moderate Rosacea Symptoms May Include:

• Facial redness becomes more intense
• The appearance of mild sunburn or windburn occurs
• Papules, pustules and swelling often develop; Centro-facial pores enlarge
• Swelling occurs in the cheek and nose area.
• In areas of facial redness, tiny broken blood vessels and red bumps may also become visible.
• Burning and itching sensations intensify

Left Untreated Rosacea can Progress to the Final Stage -- Severe Rosacea Symptoms Include:

• Intense facial flushing, permanent redness and severe facial swelling
• An increase in papules, pustules and the appearance of deep inflammatory nodules.
• Extreme facial hyper-sensitivity and intense burning sensations
• Facial swelling
• Spread of excess facial tissue called fibroplasia may develop