Acne vs. Rosacea

I have recently had several patients in my dermatology practice who have been misdiagnosed as having acne when in fact they have had rosacea.

On examination, both these conditions can look similar and therefore be misdiagnosed as both present with red bumps (or papules) and pustules on the face.

Acne occurs from the onset of puberty and can continue into the 20s or 30s whereas rosacea tends to occur in slightly older women and men with fair skin. It is often incorrectly called ‘adult acne’.

Patients with rosacea tend to flush and have more sensitive skin, while patients with acne have more oily skin and large pores. The big difference upon examination is that the patients with rosacea have no blackheads or whiteheads, whereas patients with acne do have blackheads and whiteheads.

Patients with rosacea tend to have small pustules whereas acne patients have deeper pustules and can have cysts that can produce scarring.

The treatment of the two conditions is different.

As patients with rosacea have more sensitive skin, I always recommend gentle products such as a gentle cream cleanser with no fragrances or active ingredients and I advise that they should avoid toners or scrubs. Moisturisers should be gentle and help to reduce redness and maintain a healthy skin barrier.

Patients with acne can use products that are formulated to improve acne such as a mild foaming cleanser with low percentage salicylic acid and a Micellar water toner. Serums or oil-free moisturisers with active like glycolic acid also help to reduce the symptoms of acne. Many people believe if you have acne you should use harsh cleansers or exfoliators to ‘scrub’ away the acne causing irritation and inflammation – it is already an inflammatory condition and harsh treatments can make it worse rather than better.

Topical treatment for rosacea would include Metronidazole gel or Azelaic acid. The mainstay of acne treatment is the topical Retinoids and Benzoyl Peroxide.

Oral tetracyclines can be used for both conditions. For rosacea, tetracyclines work via an anti-inflammatory mode of action whereas in acne the tetracyclines have both an anti-bacterial and anti-inflammatory mode of action.

Hormonal treatments such as the contraceptive pill will help for acne but not for rosacea.

Acne can be cured with a proper full course of Isotretinoin while rosacea may respond to a low dose of Isotretinoin but unfortunately, rosacea tends to be a chronic, relapsing condition.

Very rarely, some patients may have acne as well as rosacea at the same time – this makes the diagnosis and treatment more difficult.

If you are not sure whether you have acne or rosacea, I would recommend consulting your local Dermatologist.