Differentiating Acne Vulgaris vs. Acne Rosacea
Acne vulgaris is what most people think of when they hear acne. However another type of acne, called acne rosacea (usually referred to as just rosacea) needs a different type of treatment then acne vulgaris. It is important to be able to differentiate the two diagnoses.
Introduction to Differentiating Acne Vulgaris vs. Acne Rosacea
Acne vulgaris and acne rosacea are two commonly seen rashes that affect the face. While the two are often confused by patients given their looks, both conditions are characteristically distinct in the ways the can affect the skin.
Acne vulgaris (commonly referred to as acne) is a common skin disease in which hair follicles become clogged with dead skin and oils resulting in inflammation. Acne has a varied etiology which includes genetics, hormonal function, bacterial growth, and other causes.
Clinically, ance can be identified by open or closed comedones, and/or by erythematous papules and pustules on the face, as well as erythema on the surrounding skin. Likewise, acneiform scarring may also occur which may or may not present with comedones.
Acne rosacea (commonly referred to as rosacea) is a common skin disease which is characterized by redness, papules, pustules, and swelling. Commonly mistaken for acne vulgaris in its early stages, acne rosacea is a relapsing condition, which can be exacerbated by sun exposure, heat, alcohol, strong emotions, caffeine, and spicy foods.
Clinically, rosacea is largely identified by the intense reddening of the skin (the erythema is caused by dilation of the superficial vasculature of the face). Likewise, rosacea does not typically present with comedones.
Rosacea is a long-term skin condition that mainly affects the face. It’s more common in women and people with lighter skin, but symptoms can be worse in men. Treatment can help with symptoms.
Check if you have rosacea
The first signs of rosacea include:
redness (blushing) across your nose, cheeks, forehead and chin that comes and goes
a burning or stinging feeling when using water or skincare products
The redness may be harder to see on darker skin.
As rosacea gets worse, your cheeks, nose, skin and forehead will be red all the time.
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Other symptoms can include:
- dry skin
- swelling, especially around the eyes
- yellow-orange patches on the skin
- sore eyelids or crusts around roots of eyelashes – this could be blepharitis
- thickened skin, mainly on the nose (usually appears after many years)
It’s not known what causes rosacea, but some triggers can make symptoms worse. Common triggers for rosacea include:
- spicy foods
- hot drinks
- aerobic exercise like running
If you’re not sure it’s rosacea
Rosacea can look a lot like other conditions, such as:
- contact dermatitis, seborrhoeic dermatitis and other types of dermatitis
- keratosis pilaris
Non-urgent advice: See a GP if:
- you think you have symptoms of rosacea
Coronavirus update: how to contact a GP
It’s still important to get help from a GP if you need it. To contact your GP surgery:
- visit their website
- use the NHS App
- call them
Urgent advice: Ask for an urgent GP appointment or call 111:
If you have rosacea and:
- your eye is painful
- your vision is blurred
- you’re sensitive to light
- you have a red eye
- your eye feels gritty
These could be signs of keratitis, which can be serious if not treated urgently.
Treatment for rosacea from a GP
Rosacea cannot be cured but treatment from a GP can help control the symptoms. It can get worse if it’s not treated.
A GP may suggest:
- prescriptions for creams and gels you put on your skin
- taking antibiotics for 6 to 16 weeks
- IPL (intense pulsed light) treatment – this may not be available on the NHS
The GP may refer you to a skin specialist (dermatologist) if treatments are not working.
Things you can do to help
Rosacea is not caused by poor hygiene and it’s not contagious. But there are things you can try to help with symptoms.
If you know that a trigger, for example alcohol or spicy food, makes symptoms worse, try to avoid it as much as possible.
wear a high SPF sunscreen of at least SPF 30 every day
try to avoid heat, sunlight or humid conditions if possible
try to cover your face in cold weather
use gentle skincare products for sensitive skin
clean your eyelids at least once a day if you have blepharitis
do not drink alcohol
do not have hot drinks
do not have too much caffeine (found in tea, coffee and chocolate)
do not eat cheese
do not eat spicy food
do not do too much aerobic exercise, like running
Find out more
The charity Changing Faces can offer advice and support if you’re feeling anxious or depressed. Call the helpline on 0300 012 0275.
Page last reviewed: 15 January 2020
Next review due: 15 January 2023
What Is Rosacea?
Articles On Rosacea
Rosacea — What Is Rosacea?
- What Is Rosacea?
- When to See Your Doctor
- Diagnosis and Treatment
If your face looks like you’re blushing and you get bumps that are a bit like acne, you might have a skin condition called rosacea. Your doctor can suggest medicine and other treatments to manage your symptoms, and there are plenty of steps you can take at home to make yourself look and feel better.
The biggest thing you’ll notice is redness on your cheeks, nose, chin, and forehead. Less often, the color can appear on your neck, head, ears, or chest.
After a while, broken blood vessels might show through your skin, which can thicken and swell up. Up to half of people with rosacea also get eye problems like redness, swelling, and pain.
Other symptoms you may get are:
- Stinging and burning of your skin
- Patches of rough, dry skin
- A swollen, bulb-shaped nose
- Larger pores
- Broken blood vessels on your eyelids
- Bumps on your eyelids
- Problems with seeing
Your rosacea symptoms can come and go. They might flare up for a few weeks, fade, and then come back.
Getting treatment is a must, so make sure you see your doctor. If you don’t take care of your rosacea, redness and swelling can get worse and might become permanent.
What Causes It?
Doctors don’t know exactly what causes rosacea. A few things that may play a role are:
Your genes. Rosacea often runs in families.
Blood vessel trouble. The redness on your skin might be due to problems with blood vessels in your face. Sun damage could cause them to get wider, which makes it easier for other people to see them.
Mites. They’re tiny insects. A type called Demodex folliculorum normally lives on your skin and usually isn’t harmful. Some people, though, have a heightened sensitivity to the mites, or more of these bugs than usual.. Too many mites could irritate your skin.
Bacteria. A type called H. pylori normally lives in your gut. Some studies suggest this germ can raise the amount of a digestive hormone called gastrin, which might cause your skin to look flushed.
Some things about you may make you more likely to get rosacea. For instance, your chances of getting the skin condition go up if you:
- Have light skin, blonde hair, and blue eyes
- Are between ages 30 and 50
- Are a woman
- Have family members with rosacea
- Had severe acne
There isn’t a cure for rosacea, but treatments can help you manage the redness, bumps, and other symptoms.
Your doctor may suggest these medicines:
- Brimonidine (Mirvaso), a gel that tightens blood vessels in the skin to get rid of some of your redness.
- Azelaic acid, a gel and foam that clears up bumps, swelling, and redness.
- Metronidazole (Flagyl) and doxycycline, antibiotics that kill bacteria on your skin and bring down redness and swelling.
- Isotretinoin (Amnesteem, Claravis, and others), an acne drug that clears up skin bumps. Don’t use it if you’re pregnant because it can cause serious birth defects.
It can take you a few weeks or months of using one of these medicines for your skin to improve.
Your doctor may also recommend some procedures to treat your rosacea, such as:
- Lasers that use intense light to get rid of blood vessels that have gotten bigger
- Dermabrasion, which sands off the top layer of skin
- Electrocautery, an electric current that zaps damaged blood vessels
DIY Skin Care for Rosacea
There’s a lot you can do on your own. For starters, try to figure out the things that trigger an outbreak, and then avoid them. To help you do this, keep a journal that tracks your activities and your flare-ups.
Some things that often trigger rosacea are:
- Hot or cold temperatures
- Hot baths
- Hot or spicy foods or drinks
- Intense exercise
- Medicines such as blood pressure drugs or steroids you put on your skin
Also try to follow these tips every day to help fade the redness on your skin:
Put on sunscreen. Use one that’s a broad spectrum (blocks UVA and UVB rays) and SPF 30 or higher whenever you go outside. Also wear a wide-brimmed hat that covers your face.
Use only gentle skin care products. Avoid cleansers and creams that have alcohol, fragrance, witch hazel, and other harsh ingredients. After you wash your face, gently blot your skin dry with a soft cloth.
Use a moisturizer. It’s especially helpful in cold weather. Low temps and wind can dry up your skin.
Massage your face. Gently rub your skin in a circular motion. Start in the middle of your face and work your way outward toward your ears.
Cover up. Put a green-tinted cover-up on your face to hide redness and broken blood vessels.
Go indoors. Get out of the heat and sun and cool off in an air-conditioned room.
Care for your eyes. If rosacea has made them red and irritated, use a watered-down baby shampoo or eyelid cleaner to gently clean your eyelids every day. Also put a warm compress on your eyes a few times a day.
Eating an anti-inflammatory diet, like a Mediterranean diet, seems to help some people suffering from rosacea.
It’s also important to care for your emotions along with your skin problems. If you feel embarrassed by the way you look, or you think it’s starting to affect your self-esteem, talk to your doctor or a counselor. You can also join a support group where you can meet people who know just what you’re going through.
American Academy of Dermatology: «Rosacea: Signs and Symptoms,» «Rosacea: Tips for Managing,» «Rosacea: Who Gets and Causes.»
Mayo Clinic: «Metronidazole (Oral Route),» «Rosacea: Self-Management,» «Rosacea: Symptoms and causes,» «Rosacea: Treatment.»
National Institute of Arthritis and Musculoskeletal and Skin Diseases: «Rosacea.»
National Rosacea Society: «All About Rosacea,» «Coping With Rosacea,» «Lasers Used to Treat Some Rosacea Signs,» «Understanding Rosacea.»
NHS: «Rosacea — Causes.»
National Institutes of Health: «Red in the Face.»
National Library of Medicine: «Azelaic Acid Topical.»