Rosacea vs acne: how to tell them apart

Rosacea and acne are two separate skin conditions that can look alike. Both can cause red bumps and bumps filled with pus. They need different care, and some common acne products can irritate rosacea. The American Academy of Dermatology (AAD) recommends a board-certified dermatologist to find out which condition is causing your skin problem. This guide explains the signs that differ, why acne products can be a problem for rosacea, and what a doctor may offer for rosacea bumps. It cannot tell you which condition you have. Only a doctor can confirm that.

For an overview of the condition, start with what rosacea is.

Why the two get confused

The AAD says many people with rosacea get acne-like breakouts. Doctors use the same names for these bumps in both conditions: papules, which are raised red bumps, and pustules, which are bumps filled with pus. The NHS uses the same two words in its list of acne spots. The AAD says rosacea bumps appear on all skin tones, that the face may also feel oily, and that these signs are often mistaken for acne.

"Acne rosacea" is a name many people use for rosacea with these bumps. The bumps are still rosacea. On darker skin, the AAD says bumps may be the first sign of rosacea a person sees, which makes the mix-up even more likely.

The AAD's overview puts it plainly: people mistake rosacea for acne, sunburn or a skin reaction. The NHS lists acne first among the conditions that rosacea can look like.

The signs that differ

The table compares what the AAD and the NHS list for each condition. Use it to prepare for a talk with your doctor. It cannot replace an exam.

Sign	Rosacea	Acne
How it starts	Often with flushing that lasts longer over time (AAD)	Clogged pores (AAD)
Whiteheads and blackheads	Not on the AAD or NHS rosacea lists	Listed as acne spots (NHS)
Lasting redness in the center of the face	The most common sign (AAD)	Not on the NHS acne list
Burning or stinging from products or water	Some people have it (AAD)	Not on the NHS acne list
Visible blood vessels	Many people, easier to see on lighter skin (AAD)	Not on the NHS acne list
Eye symptoms	Half of people with rosacea, by the AAD's estimate	Not on the NHS acne list
Where it shows	Mainly the nose and cheeks (AAD)	Usually the face, chest and back (NHS)
Typical age	More likely after 30 (AAD)	Most common in teenagers (AAD)

The AAD says acne develops when pores become clogged, and that hormones may explain why acne is so common in teenagers. It says nearly everyone gets at least a few breakouts during the teenage years. The NHS lists the types of acne spots: whiteheads, which are small bumps usually the same color as the skin; blackheads, which are black or brown spots; papules; pustules; and larger lumps called nodules and cysts.

Rosacea's signs are different. The AAD lists flushing, redness or a violet or brown color that lasts, acne-like bumps, visible blood vessels, burning or stinging, dry skin, eye problems and, less often, thickened skin. It says the chance of getting rosacea rises after age 30.

Clues that point to rosacea

If you have bumps plus any of these, mention them to your doctor:

• Redness in the middle of the face that stays for weeks or longer
• Flushing more often than before, or flushing that lasts longer
• Burning or stinging when you apply products, or even water
• Thin red lines on the cheeks or nose
• Eyes that feel gritty, dry or sore, or red and swollen eyelids
• Flares after sun, heat, hot drinks, alcohol or spicy food
• Bumps that acne treatment does not clear

The AAD lists "acne-like breakouts that acne treatment won't clear" as a sign of rosacea on darker skin. In its overview it asks whether you have acne-like bumps that nothing seems to clear. If the answer is yes, the AAD says you might have rosacea.

If your spots fit the usual acne pattern, Skinli's guide to the acne skincare routine covers the standard over-the-counter steps. If breakouts sit along the jaw and flare with your cycle, see hormonal acne vs regular acne.

Why acne products can irritate rosacea

Rosacea often makes the skin sensitive, and the AAD names several ingredients common in acne products that can irritate it.

The AAD says benzoyl peroxide can irritate sensitive skin, which makes it an unacceptable treatment for rosacea. The only exception it describes is a prescription cream in which the benzoyl peroxide is wrapped in tiny capsules that release it slowly. The AAD's rosacea skin care page also advises avoiding products with glycolic acid or lactic acid, along with alcohol, fragrance, menthol, camphor, urea and sodium lauryl sulfate. It says never to use an astringent or toner, and to stop exfoliating.

This is one reason a correct diagnosis matters. Treating rosacea as acne with strong acne products can leave the face redder and more irritated. The AAD says that if a product makes your face burn, sting or itch, or leaves it dry and scaly, it is irritating your skin, which can cause rosacea to flare.

What a doctor may offer for rosacea bumps

For rosacea's acne-like bumps, the AAD says a medicine applied to the skin is often effective. It says you may see some improvement in 3 or 4 weeks, and it usually takes 2 to 3 months to see a noticeable difference. If a skin medicine does not work, or stronger treatment is needed, antibiotic pills may be part of the plan.

The AAD lists these FDA-approved options for rosacea bumps, which a dermatologist may prescribe:

• Azelaic acid, as a foam or gel
• Benzoyl peroxide wrapped in tiny capsules that release it slowly, which makes it gentler on rosacea skin
• Ivermectin cream
• Metronidazole cream, gel or lotion
• Minocycline foam
• Low-dose doxycycline, taken by mouth at a dose too low to act as an antibiotic

Your dermatologist chooses among these based on your skin, and explains how to use each one. Follow their directions exactly. The guide to how rosacea is treated covers the options for redness, blood vessels, eyes and thickened skin as well.

Can you have both?

The sources checked for this guide do not directly answer whether a person can have acne and rosacea at the same time. They do show links between the two. The AAD lists a history of many acne breakouts, or acne cysts and nodules, as a factor that raises the chance of getting rosacea. It also lists having a blood relative with rosacea or severe acne.

If you have had acne before and now notice redness, flushing or burning, tell your dermatologist about both. They can tell which bumps belong to which condition and plan care that does not irritate either one.

Other conditions that look like both

Acne and rosacea are only two of the possibilities. The NHS lists contact dermatitis (a rash from something that touches the skin), seborrhoeic dermatitis (a red rash with flaky scales), lupus and keratosis pilaris (small, rough bumps) as conditions that can look like rosacea. On darker skin, the AAD adds allergic reactions. A dermatologist can tell these apart with an exam, and with tests when needed. The guide to what rosacea looks like explains how the diagnosis is made.

What to tell your doctor

A clear history helps a dermatologist tell rosacea from acne. Before your visit, write down:

• Which acne products you have tried, for how long, and how your skin reacted. Redness or burning after acne products is worth mentioning.
• When the redness started, and whether it comes and goes or stays.
• What seems to set off flushing, such as sun, heat, hot drinks, alcohol or spicy food.
• Any eye symptoms, such as grit, dryness, burning or red eyelids. The AAD says rosacea can affect the eyes, sometimes before the skin.
• Whether a close relative has rosacea or severe acne, which the AAD lists as a risk factor for rosacea.
• Every medicine you take. The AAD says some medicines can make rosacea worse.

Photos from days when your skin looks its worst can help too, because the AAD says rosacea signs come and go and may not show on the day of the visit.

Daily care that suits rosacea skin

For rosacea-prone skin, the AAD recommends a mild cleanser applied with the fingertips, a fragrance-free moisturizer, and a broad-spectrum sunscreen of SPF 30 or higher every day. It also suggests testing any new product on a small area of skin before using it on your face. Skinli's guide to patch testing a new product shows how.

For the full list of rosacea-friendly habits, see skincare for rosacea.