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Does Rosacea Progress In Stages?

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First off what are 'stages' of rosacea?  Usually in past literature on rosacea stages refer to the 'subtypes' of rosacea. 

In many reports on rosacea, especially those written in the past, rosacea is spoken of as progressing in stages and that the progression leads to rhinophyma (Phenotype 5). For example, note this report from Better Medicine, Heathgrades, discussing the 'stages of rosacea" from mild to moderate to severe to rhinophyma rosacea, implying that rosacea progresses in stages. [1] A CNN Health Report on the Stages of Rosacea in 2017 continues this myth. You may find similar reports that imply or state that rosacea progresses into stages.

However, current thought on this subject is far from this idea and simply isn't proven to be true. For example note these reports:

“The notion that the erythematotelangiectatic stage generally transforms into the papulo-pustular, inflammatory stage is simply wrong and grossly misleading. Firstly, the papulo-pustular stage mainly occurs in males in whom rosacea is a more serious disease at all stages. The papulo-pustular stage is actually uncommon in females.” [2]

“Rosacea is often divided into four stages, according to the progressive nature of the condition. However, the progression is not absolute. For unknown reasons, certain patients may skip a stage. Others experience ocular symptoms as the first manifestation of the condition.” [3]

Also, there is controversy on the classification of rosacea into subtypes and variants which is related to this subject. Current types are now considered to be phenotypes, so the subtype classification is not the current classification. The Phenotype classification is superior to the subtype classification. There is no data suggesting that you move progressively through the six phenotypes of rosacea. While you may have more than one phenotype at the same time, there is nothing indicating you will progress in stages through each one. 

One report concluded that "A small proportion of rosacea subjects may progress between subtypes." [4]

"Although rosacea findings may change over time, no proven natural progression exists.[5]

Conclusion

While any rosacea sufferer may indeed have a case of rosacea that gets worse, it does not mean that every rosacea sufferer progresses from a mild stage of rosacea into stages that get worse. The consensus is that if you fail to treat rosacea it will probably get worse, but not necessarily in 'stages' which is usually referring to the former subtypes and now is considered the phenotypes of rosacea.  

End Notes

[1] The Stages of Rosacea, Better Medicine, Heathgrades

[2] A Personal Critique on the State of Knowledge of Rosacea Albert M. Kligman , M.D., Ph.D.
Department of Dermatology, University of Pennsylvania, Philadelphia, PA, U.S.A.
The William J. Cunliffe Lectureship 2003—Manuscript

[3] Consult Your Pharmacist
Differentiating Between Rosacea and Acne
W. Steven Pray, PhD, DPh; Joshua J. Pray, PharmD candidate :U.S. Pharmacist

[4] Br J Dermatol. 2013 Apr 21. doi: 10.1111/bjd.12385. [Epub ahead of print]
An observational cross-sectional survey of rosacea: Clinical associations and progression between subtypes.
Tan J, Blume-Peytavi U, Ortonne JP, Wilhelm K, Marticou L, Baltas E, Rivier M, Petit L, Martel P.
Department of Medicine, University of Western Ontario, London, Ontario and Windsor Clinical Research Inc., Windsor, Ontario, Canada.

[5] Am Fam Physician. 2015 Aug 1;92(3):187-196.
Rosacea: Diagnosis and Treatment
LINDA K. OGE', MD, HERBERT L. MUNCIE, MD, AMANDA R. PHILLIPS-SAVOY, MD, MPH

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