Stages - Plewig and Kligman Classification of Rosacea

Stage I: The symptoms of 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, cheeks, 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 treatments using 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 photodamaged skin becomes 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 facial area 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 symptoms of the disease, namely large inflammatory nodules, furunculoid infiltrations, and tissue hyperplasia. These symptoms 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 facial appearance becomes evident when photographs from previous years are reviewed. Finally, the patient shows symptoms of diffusely inflamed, thickened, facial edematous skin with large pores, resembling the peel of an orange. These coarse features are due to extensive 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 faces of leprosy or leukemia. The ultimate deformity is the phymas, of which rhinophyma is the prototype. (Drs. Plewig & Kligman)

Rosacea Progression: The facial redness begins and gradually becomes more persistent with spidery blood vessels (telangiectasis) becoming progressively prominent on the nose and cheeks. Trauma from treatments involving abrasives and peeling agents (Retin - A and all other retnoids, steroids, and exfoliants including anti-aging treatment 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 more prominent. If there has been much sun exposure damage over the years, the skin becomes more leathery skin becomes more wrinkled as it is not elastic or as soft to bend. 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 patients realize they have a more serious presentation of the disease with the condition of nose tissue hyperplasia beginning. Hypergenesis is a general term referring to the proliferation of cells within an organ or tissue beyond that which is ordinarily seen as is indicative of cancer cells expansion. "Rosacea is more than a red face" as patients often have symptoms of allergy and sinus problems, fibromyalgia, digestive system disorders, and in later years osteoporosis and arthritis - rheumatism presents itself along with a lowering of the total immune system. As you read our new rosacea research facts page, you will find that rosacea is just one symptom of a "metabolic acidosis" disorder.

It is often the cumulative effect of the treatments you've been using to treat your rosacea that may actually be the aggravating source or factor of your current treatment. Improving the skin involves a complete change in your thought processes and your approach to treating and controlling your rosacea. Rosacea Ltd believes that total skin care and treatment involves much more than treating the symptoms of damage that has already occurred. Effective rosacea treatment and skin care also involves preventive skin care. The use of sun screens is just one of these preventive skin care treatment measures.

Many patients have been frustrated for many years with unsuccessful or marginal results from many rosacea skin care products. Antibiotics, retnoids, Accutane, and steroids have been a mainstay of rosacea treatment for years. Rosacea sufferers have noticed that these prescribed treatments and various rosacea laser treatments have not worked well as a skin care treatment; also these past treatments for rosacea may have caused additional damage to the already sensitive skin. Oral and topical antibiotic treatments for adult acne rosacea can work for up to several months before the bacteria become immune to the antibiotic treatment, causing the antibiotic to lose its effectiveness. Oral antibiotic treatments actually cause more symptoms of facial redness. For information on the latest FDA findings, see Bacterial Resistance to Antibiotics.

Rosacea can also result in symptoms such as a persistent burning and feeling of grittiness in the eyes or inflamed and swollen eyelids with small inflamed bumps, eye lashes sometimes fall out, compounded by bloodshot eyes. (Dr. Thiboutot) The ocular symptoms of rosacea are exceedingly variable, including blepharitis, conjunctivitis, iritis, iridocyclitis, hypopyoniritis, and even keratitis. The term ocular rosacea covers all these signs. The ocular complications are independent of the severity of facial rosacea. Keratitis has an unfavorable prognosis, and in extreme cases can lead to corneal opacity with blindness. The most frequent symptoms of ocular rosacea, which may never progress, is chronically inflamed margins of the eyelids with scales and crusts, quite similar to seborrheic dermatitis, with which it is often confused. Symptoms including pain and photophobia may be present. It is instructive in the treatment of ocular conditions to ask patients how their eyes react to bright sunlight. (Drs. Gerd Plewig & Albert M. Kligman).

The circulatory network of the skin is extensive and the capillaries are the smallest, most delicate vessels. During normal blood circulation the capillaries undergo constant changes. In between beats the pressure is relieved and the vessels constrict back to their normal size. This return to normal size is accomplished by the natural elasticity in the structure of the capillary. If telangiectasis is present, the capillaries' elasticity is deteriorated so they remain slightly dilated. The constant influx of blood perpetuates this slight dilation. The skin gradually becomes congested and eventually the capillaries become visible through the skin's surface. When it comes to telangiectasis, sometimes a person's lifestyle and habits can be the skin's worst enemy. In a fair, delicate skin predisposed to telangiectasis, a steady diet of hot, spicy food, chronic alcohol consumption, and eating meals too quickly will promote telangiectasis. Many retinoids used for acne treatment as well as many harsh soaps continue to aggravate the skin resulting in an increase in redness.

The Treatment Research team at Rosacea Ltd were the pioneers in research studies of skin diseases that can and often do co-exist with rosacea. Our findings are that 82% of the patients with rosacea display symptoms of adult acne or "acne rosacea" (raised red lesions with pus caused by a bacterial component that comes to a head before erupting from a white/yellow center.) While 35% of rosacea patients have seborrheic dermatitis which makes for a most delicate skin condition. These three co-existing facial skin conditions often lead initially to mis-diagnosis or delayed diagnosis of rosacea. This delay in the diagnosis of rosacea can result in increased mental suffering or embarrassment for the patient. Treatments such as retinoids, accutane, steroids, laser therapy treatment, and antibiotics have not worked very well and often aggravate, redden, or thin the skin which can cause further sensitivity as most acne treatment products are too aggressive for use in rosacea treatment. Our objective with Rosacea Ltd III is to simply do the opposite of most treatments by leaving the sensitive skin intact on the face. Most patients have spent many years and much money in their search for the best rosacea treatment yet have only ended up most frustrated. Treatment and control of rosacea is easy, fast and very inexpensive when the cause is understood as the proper management of your symptoms can be utilized. The management of rosacea is easier and more effective the quicker that the proper treatment is started. Rosacea does not have to be painful and hinder the patients professional or social life.

Improve your skin, health, and rosacea with the total skin and body care protocol of Rosacea Ltd! Rosacea Ltd III will improve the appearance of the symptoms of facial flushing, pimples, and papules. Users of Rosacea Ltd have seen improvement in skin that is sensitive or inflamed due to rosacea, seborrheic dermatitis, and acne. Initial studies of rosacea test subjects indicate that 98% of previous Rosacea Ltd users confirm that Rosacea Ltd is extremely effective in soothing and conditioning the skin to lessen the appearance of facial redness (erythema), dilated facial vessels (telangectasia), as well as rosacea-related papules (raised red lesion without pus) and acne pimples (with pus due to bacteria.)

Years of innovative research has lead to the development of our new effective Rosacea Ltd III which specializes in leaving the skin barrier intact with an 'invisible application' that penetrates and migrates so that only a very small amount is needed. There are no side effects of any type. Also Rosacea Ltd III does not affect any other treatment or medication in any way; nor does Rosacea Ltd affect pregnancy or nursing infants. Rosacea Ltd III can be applied to skin that is sensitive due to rosacea, seborrheic dermatitis, and acne. The actual physical shape was made for ease in applying the disks around the contours of the face and eyelid.