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Does Rosacea Progress In Stages?

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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. For example, note this report discussing the 'stages of rosacea" from mild to moderate to severe to rhinopehyma rosacea, implying that rosacea progresses in stages. [1] 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. 

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

End Notes

[1] The Stages of Rosacea, from Better Medicine from 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.

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