If it seems like you developed rosacea totally out of the blue, the truth is that you’ve probably had symptoms for a while but just didn’t notice (or realize they were pointing to the early stages of rosacea). “Rosacea can vary in its progression and appearance, but for many people, it's a chronic progressive disease,” says Dr. Ilyas. “It starts with flushing or blushing that comes and goes—this initial stage is often missed or considered to just be how our skin naturally behaves without realizing the progression [to rosacea].” Eventually, without treatment, you will notice more persistent flushing, followed by skin that fluctuates between feeling oily and flaky or dry, as well as skin more prone to breakouts, she adds. At this point, many people wonder what happened to their skin; by the time they get to a dermatologist and are diagnosed with rosacea, the onset seems sudden to them, though they’ve likely been experiencing mild symptoms for a long time. The other reason that rosacea often seems to have a sudden onset is how under-diagnosed the condition is in non-white people, says Dr. Ilyas, since it’s typically associated with fair skin or people of Northern European ancestry. “I routinely have patients of color that have seen numerous other doctors and had their diagnoses missed, simply because their skin type did not show the classic ‘rosy cheeks’ since it’s not as apparent [in darker skin tones],” she says.