Pimples are the enemies of clear skin. Most of us tackle these invaders head-on with a handful of common products. But if your acne-busting creams, serums and washes aren’t getting results, maybe you have a different condition on your hands.
Rosacea can look a lot like acne, but it’s not the same issue at all. Let’s get into their key similarities and differences — and how you can safely and effectively treat both.
Acne is a skin condition where hair follicles become clogged with dead skin cells, oil and bacteria, triggering inflammation. Pimples are its most common symptom, with a wide variety of presentations: Think whiteheads, blackheads and more, as well as redness, swelling, heat and pain. Acne affects up to 50 million Americans and can stem from a variety of factors, from hormone changes to genetics to diet, medication or stress.
Rosacea, on the other hand, is characterized by intense reddening of the skin, visible blood vessels and acne-like bumps or pimples. It’s a relapsing condition that can affect anyone, though it tends to run in families and is most common among middle-aged white women. About 14 million Americans experience rosacea. It tends to set in between ages 30 and 60, while acne usually makes its first appearance around puberty.
We haven’t found one definitive cause of rosacea, though there are theories: It could be an overactive immune response that triggers inflammation, or an excessive presence of Demodex mites, a microorganism that lives on the skin and releases bacteria when it dies. That said, rosacea flare-ups generally have an external trigger, such as sun exposure, heat, alcohol, caffeine, spicy food or even strong emotions.
Because both conditions involve inflammation, redness and pimples, and both often occur on the face, they’re frequently mistaken for one another, says Dr. Cheryl Rosen, a New York-based dermatologist. No wonder — one 2013 survey from the National Rosacea Society found that acne-like bumps are one of the top three symptoms rosacea patients experienced. However, there are some simple ways to tell the two apart.
First, while acne can be found elsewhere on the body (bacne, anyone?), rosacea only occurs on the face. And while rosacea is characterized by widespread redness, the redness from acne is only found right around pimples or bumps. Rosacea bumps can closely resemble whiteheads, but if you have a blackhead, you can be confident that you’re just dealing with acne.
Differences in treatment
While both acne and rosacea can be treated with topical medications and oral antibiotics, Rosen says the similarities stop there.
When it comes to acne treatment, the name of the game is getting rid of oil and clearing pores. Topical treatments for acne include astringents, acids and retinoids to help kill the bacteria and exfoliate the skin, while oral meds include antibiotics and certain birth control pills.
Treatment for rosacea, on the other hand, focuses on reducing inflammation and flushing. This generally comes in a combination of sensitive skincare and prescription drugs. Some courses include topical drugs that reduce flushing by constricting blood vessels and oral antibiotics (most typically metronidazole) that control inflammation. While some topical treatments for rosacea are prescription, you can find a number of over-the-counter products that will help, like creams containing azelaic acid.
While acne and rosacea symptoms can look similar, medication for one can sometimes worsen the other. “Patients with rosacea tend to have sensitive skin, which can be very much irritated by some of the harsher topical medications that are used to treat acne,” says Dr. Robin Evans, a dermatologist in Connecticut. Acne-fighting ingredients like glycolic acid, lactic acid and topical retinoids can make rosacea worse.
This all means it’s essential that you know which condition you’re dealing with, which often requires seeing a professional.
Seeing a derm
You usually don’t have to see a dermatologist to treat pimples. However, if your acne is particularly persistent or painful or becomes cystic, or if you can’t seem to treat even the slightest bumps with OTC products, you might want to make an appointment.
There’s no specific test for rosacea, so dermatologists will make a diagnosis by examining your skin, learning your medical and family history and ruling out other skin conditions, like psoriasis or lupus. Once you have a diagnosis, the dermatologist will determine the care protocol that’s best for your individual case, which might involve prescriptions, skincare products, trigger avoidance or some combination of these.
“Both conditions can be difficult to deal with,” says Rosen. “So it’s important to get the help of a medical professional if you’re struggling with either one.”
Once you do, the outlook is rosy — at least in the figurative sense.