Rosacea can begin with a “blush” or redness that progresses from intermittent to constant. This “blush” or general redness may be followed or preceded by distinct or individually recognized larger blood vessels. The severity of redness can increase as a result of the following stimuli: Heat Exercise Stress Alcohol consumption Hot beverage consumption (especially caffeine according to some patients) Spicy food Various other foods, such as chocolate Rubbing or skin irritation These stimuli are believed to produce dilation or widening of the blood vessels. An increased amount of blood and/ or blood vessels produces the increased red color. In many patients, flares are associated with symptoms such as flushing, burning, stinging and/or tingling. The natural course of Rosacea may include episodes of improvement and worsening. Obviously, patients with Rosacea should attempt to avoid any conditions or substances that may cause their condition to flare or worsen. Patients with pimples [papules (red bumps) and/or pustules (red bumps with white pus at their tops)] may subsequently develop the severe enlargement of the nose called Rhinophyma. Rhinophyma is a relatively rare and a later manifestation of Rosacea.