Everyone gets a little pink after a couple of glasses of red wine, but you get pink faster and stay that way longer. Even though you're stone-cold sober, it makes you feel like you can't hold your liquor.

Sties were a frequent irritation when you were a kid. Now, years later, your eyes feel like they're full of dust even if you're in a clean environment and not wearing contact lenses.

You're 30 years old, the years of teenage acne well behind you. Or so you thought until you looked in the mirror one day and saw a rash of pimples and bumps across your cheeks. How embarrassing.

Some people would tell you it could be worse. They've got bumps of scar tissue building up on their noses, turning them into modern-day replicas of W.C. Fields.

The symptoms described above are widely different, but the diagnoses from a dermatologist would be the same: They've all got an incompletely understood skin disease called rosacea, and they're far from alone. It has been estimated that somewhere between 14 million and 25 million Americans suffer from it. Among them, according to a New York Times article quoted by the National Rosacea Society, is former President Bill Clinton.

It is primarily a disease of adults, striking those between 25 and 60, but doctors interviewed for this piece have seen it in patients as young as 10.

Rosacea has no cure, and no one has come up with a scientifically proven cause, though it appears to be more prevalent among those with fair skin and light eyes. It is also generally accepted that rosacea sufferers blush more easily, more deeply for longer periods of time and to a lower stimulus. According to one study, those stimuli, usually called triggers, include hot foods and beverages, spicy foods, red wine and emotions.

Dermatologists vary widely on observations about the disease's progression (if there is any at all) and specialists don't even agree that the four subtypes described above are all examples of rosacea.

For instance, Dr. Joseph Bikowski, a clinical assistant professor of dermatology at the Ohio State University who practices at the Bikowski Skin Care Center in Sewickley, believes that phymatous rosacea, which can produce rhinophyma, or the so-called W.C. Fields nose, is not rosacea but a separate disease. The reason: "I've seen over 72,000 patients over 450,000 patient visits and never seen it in a woman," Dr. Bikowski said.

The good news: There are treatments to control or, in some cases, ameliorate the symptoms of the various manifestations of rosacea. A problem with that, though, is that there is no one standard treatment, which shows how much research is yet to be done.

"A wise old professor once told me: Whenever there's more than one treatment, it's because there's not one that is truly that effective for that condition," said Dr. Suzan Obagi, assistant professor of dermatology at the University of Pittsburgh School of Medicine and director of the UPMC Cosmetic Surgery and Skin Health Center.

"But the common theme in all the conditions is inflammation," Dr. Obagi added. "Once we get better at targeting the inflammation effectively, we will see more improvement than with current treatments."

Dr. Bikowski's opinion on phymatous rosacea, notwithstanding, here are the conventionally accepted four basic kinds of rosacea as described by Dr. Guy Webster, a clinical professor at Jefferson Medical College in Philadelphia. He also has a private practice and is the founding president of the American Acne & Rosacea Society:

• "The blushy red face type," which is a result of big, inflamed blood vessels. The official name, for the record, is erythematotelangiectatic rosacea.

• "The pimply type," of papulopustular rosacea, which includes both "papules," or bumps, and "pustules," or pimples. It is often difficult to tell those symptoms from those of acne. The basic difference is location. Adult acne usually occurs along the jaw line; rosacea usually is in the center of the face -- the cheeks and foreheads. "But patients can have both," Dr. Webster said. "It takes a skillful doctor to tell them apart and treat them accordingly.'

• "Phymatous rosacea," which is an overgrowth of oil glands accompanied by fibrosis. This overgrowth can lead to a nose like that of W.C. Fields. But Dr. Webster and Dr. Obagi stressed the big, bulgy nose has nothing to do with alcoholism. "A big schnozz doesn't mean they're a boozer," Dr. Webster said.

• "Ocular rosacea," which is an eye inflammation. "Between one-third and one-half of rosacea patients have it and often it's the first sign," Dr. Webster said. "Many people who had lots of sties as kids grow up into adults with rosacea."

Literature suggests that rosacea begins with the blushy red face and progresses into the more disfiguring subtypes.

"For the most part, it starts with turning red easily and that comes and goes," Dr. Obagi said. "Then it starts to become more persistent, then you get the postules and papules, then the enlarged blood vessels, but some just get redder and then get the broken blood vessels."

Dr. Webster said he does not believe that subtypes of rosacea necessarily morph into others -- which brings relief to his patients. "Once a week a patient says, 'Does that mean I'm going to look like W.C. Fields?' They aren't going to," he said. "It's not like one progresses to another. There's nothing to suggest it does. Patients pretty much have what they have when they present [show symptoms]. If they have blushy cheeks for 30 years, the odds of getting a W.C. Fields nose are tiny."

As Dr. Obagi noted, treatment varies, but the main target remains reducing the inflammation, and the doctors interviewed all have refined their own system of care.

Dr. Obagi, for example, stresses patient education, pointing them to the information available on the Web site of the National Rosacea Society (rosacea.org); prescribes a sun block of zinc oxide or titanium dioxide, and adds topical agents to the regimen. The latter may target microscopic mites that live on the skin, bacteria or the inflammation. "We might add an oral anti-inflammatory antibiotic," she said. She also advises the patients to identify what triggers eruptions and try to eliminate them from their lifestyle.

Dr. Bikowski stresses skin care to make sure the outer layer, called the stratum corneum, is healthy. "That stops water from leaving, the skin from drying out, and stops things like microbes from getting in, also irritants and allergens." He advises the use of the over-the-counter cleanser, moisturizer lotion and/or moisturizer cream marketed under the name CeraVe.

Second, he tells female patients they can wear any kind of makeup they want, saying the only big differences among them are "packaging and price points. ... If it makes you happy and you can afford it, use it.

"There is nothing over the counter that is of any medical value for treating rosacea except for the skin products [CeraVe]," he said.

The medicines that can be prescribed are either topical (skin cream-based) or systemic. For the topicals, he prescribes either MetroGel 1% (metronidazole) once a day or Finacea Gel 15% (azelaic acid) twice a day.

Dr. Webster believes that the "only type truly treatable is the pimply kind." Again, the drugs of choice are either topical metronidazole and oral doxycycline. The latter, better known as Oracea, is an antibiotic but is given at such a low dose that it works only against inflammation.

He has mixed feelings about pushing patients to identify and eliminate triggers. "You can make a patient crazy with that," he said. "The big drinker who cares about his rosacea probably should stop, but you can't tell a person to have no warm food, no spicy food, and no alcohol and have a chance of getting him to comply with that. I tell them if you know something makes you really bad don't do it. Otherwise it's like telling them don't breathe, don't eat."

He also points out that while some forms of rosacea aren't medically treatable, they can be treated in other ways. Red faces, he said, can be lasered to make the red go away. "It can't be used for the blush, but for the fixed redness," he said. "The lasers destroy the rosacea blood vessels in the same way they destroy big vascular birthmarks."

The W.C. Fields nose doesn't respond medically, "but you can treat it surgically by scraping away excess skin," he added. "It's dermatologic surgery using laser or electrocautery. If done by a master it looks fantastic. By a hacker, you wish you'd never thought about it."