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The disease course of rosacea is waxing and waning in nature, with patients often experiencing periods of remission and little or no symptoms followed by episodes of "flareups", where symptoms are exacerbated. For many individuals, rosacea progresses in stages, while for others, symptoms may progress in a nonsequential manner.
The onset of rosacea may be preceded by episodic erythema (redness) that is triggered on exposure to various factors such as ultraviolet radiation, hot or cold temperature, stress, alcohol, hot drinks, or spicy food. Regular flushing and blushing can eventually cause permanent erythema across central regions of the face, as well as on the cheeks, chin, forehead and even the neck and chest.
The progression of rosacea is categorized into four main stages:
Among almost half of rosacea patients, there is involvement of the eye in disease progression. The patient experiences burning, stinging, and tearing along with a sensation of grit or sand in the eyes. There may be eye pain, photophobia, redness of the conjunctiva, swollen and inflamed eye lids (blepharitis), scaling around the eyes, and an intolerance for wearing contact lenses.
Eye involvement is independent of facial symptoms and may occur before facial redness does in some individuals. Over time, ocular rosacea can cause serious complications such as opacity of the cornea, scarring and even blindness.