Is it Rosacea, Acne, or Something Else?

A bump or pus-filled pimple may seem like run-of-the-mill acne, but often times it may be a sign of a more serious skin condition.

It can be difficult to tell the difference between rosacea and acne, says Paul M. Friedman, MD, director of the Dermatology & Laser Surgery Center in Houston and New York City

Luckily, Dr. Friedman offers some clues. With rosacea, a patient may have one symptom or a combination of symptoms, which can include a persistently red nose and cheeks, bursts of redness on the nose and cheeks, tiny thread veins, facial skin swelling, itching, burning, bumps that look like acne but come and go, and persistent yellowish bumps. Although oily skin and enlarged oil glands are commonly associated with rosacea, over-the-counter and prescription anti- acne medications such as benzoyl peroxide, may cause skin reaction rather than relief.

Acne typically occurs in younger people and involves the jawline and neck. Its telltale markers are whiteheads or blackheads, Dr. Friedman explains. Acne results from hormone fluctuations that cause excess oil secretion. However, being older doesn’t mean you can’t have acne. One in five adults between the ages of 25 and 44 gets acne breakouts.

Understanding Rosacea Signs and Symptoms

Rosacea is a chronic inflammatory disease of the skin. Those affected tend to blush or flush more easily than other people. The redness can, over time, spread from the cheeks and nose to the chin and forehead. Sometimes the back, chest, and ears are consistently red. Other signs include breakouts that look like acne or thick skin with bumps.

Rosacea is most common in people with fair skin, particularly those of English, Irish, and Scottish descent, says Bethanee J. Schlosser, MD, PhD, an assistant professor and director of the Women’s Skin Health Program in the department of dermatology at Northwestern University in Chicago. Although it can occur in all skin types, it is often less noticeable in people with darker skin.

Approximately half of all people with rosacea develop eye involvement, called ocular rosacea, with chronic tearing and eye dryness, a gritty sensation within the eye, flaking at the base of the eyelashes (called blepharitis), and recurring sties, Dr. Schlosser says.

People with rosacea typically have sensitive skin and may be unable to tolerate a variety of skin products. Rosacea often worsens with certain environmental triggers, including temperature extremes, sun exposure, emotional stress and certain foods like red wine and spicy dishes.

The exact cause of rosacea is unknown, but scientists do know that the blood vessels within the skin of rosacea patients are unstable and more reactive than those who do not have the condition.

"This blood vessel reactivity may be due to changes in nerve signaling to the blood vessels or the presence of inflammatory molecules in the skin," Schlosser says.

Demodex mites, microscopic organisms that inhabit hair follicles in low numbers but are more numerous in those with rosacea, may play a role in the development of the red bumps and pus bumps of rosacea, Schlosser says.

Seeing a Dermatologist

Complicating the picture, Schlosser says, is that rosacea symptoms can look similar to other skin problems, such as seborrheic dermatitis and lupus. But there are key ways to tell them apart. For instance, with seborrheic dermatitis, in addition to redness, a patient will see flaking in the brows, in the lower forehead between the brows, in the creases around the nose, and less often in the chin. But they won’t have the red swollen bumps or pus-filled pimples of rosacea. It’s uncommon but possible to have both seborrheic dermatitis and rosacea. With lupus, there may be redness on the cheeks and bridge of the nose but, again, not the typical red bumps of rosacea. Instead, people with lupus may have more red to brown raised areas that are flaky.

Seeing a dermatologist makes sense, first to get the right diagnosis and second to get the appropriate care. Although there are very limited over-the-counter options for treating rosacea, both topical and oral prescription medications improve not only the physical symptoms of rosacea but also quality of life, eliminating the embarrassment of what can be a very noticeable skin condition..

If rosacea is diagnosed early, it might be controlled with a gentle routine of topical medications and oral antibiotics, Friedman says. Becoming aware of any strong triggers will also help keep breakouts under control. Because rosacea is a chronic condition, you’ll want to follow up with your doctor to keep skin care on course.

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