Adult Acne? ...Or Is It Really Rosacea?

Do you experience constant redness with what look like acne breakouts?  You may be assuming you have rosacea, but it may really be adult acne, or you may have adult acne but assume it's rosacea.  Find out how to tell!
While I regard myself mostly as a specialist in adult acne, I also specialize in rosacea, as well as in general sensitivity.  And, as someone who actually has rosacea herself, I can understand the frustrations that come along with not knowing how to properly manage the condition.  This can be especially frustrating when you believe you have rosacea and it turns out it's really acne, and vise versa. 

I once had a client who’d been trying all sorts of topical and internal antibiotics and other medications, even birth control (though she was in her late 40s), and nothing was working.  In fact, most of what she was using topically was making things much worse, and what she was taking orally was helping a little or not at all (like the birth control).

After asking a few questions based on what I saw with my own eyes from 5 feet away, I realized she didn't have acne at all.  She had rosacea, and had been treated for more than a year with acne medications known to be terrible for rosacea!

Sadly, none of this surprised me.  I actually had a conversation a while back with someone at the National Rosacea Society about why their website had only a link to the database of the American Academy of Dermatology on their "find a doctor" page, rather than a list of doctors who actually specialized in rosacea.  I was told they simply didn't have a list at that time of doctors they could recommend, and since there isn't really an official specialty in rosacea per se, even the AAD database wouldn't be able to guide anyone to find a specific doctor.  

This pointed to something I was suspecting back then, which was that most dermatologists hadn't a clue what rosacea was or how to treat it.  The person on the phone actually confirmed this.  Now, this was a long time ago.  Luckily, the National Rosacea Society's current website has a link, at least, to the names of their members who are professionals.  It's a start.

This is a question I hear often.  Sometimes doctors can't even tell someone has rosacea!  Find out more on the AcneWhisperer Blog.

Light at the End of the Tunnel

The cool thing is, many of us Estheticians have been taught by the best educators in the industry, who've been privy to much of the research into rosacea by universities, as well as resident scientists at cosmetics labs.  For a long time, it seemed that the people who knew the most about rosacea were the ones trying to figure out how to help patients beyond what their doctors were able to.  Kind of like how advertisers are the best sociologists, you know what I mean?

Things in the world of Dermatology are much better now, but I still come across cases where I believe there to have been a misdiagnosis (disclaimer:  I do stay within my scope of practice and don't directly diagnose - I simply recommend skincare acccording to what I see, while remaining diplomatic and professional).

As a result of my training, I am able to teach you some very simple tricks on how to tell the difference yourself between a rosacea breakout and an acne breakout, so you can be better armed to manage the effects and symptoms of rosacea if you have it, or make more informed choices in skincare and adult acne management if you don't.

What is Rosacea?

Rosacea mainly affects people of northern European descent, but can also be experienced by people of other races, and tends to show up around the age of 30, but can also appear earlier, though not often.  The condition is marked by a chronic redness on the apples of the cheeks, center of the chin, nose and middle forehead.

In type 1 rosacea, this redness shows as a collection of visible blood vessels that looks a bit like a tiny roadmap.  During a flare-up of type 2 rosacea, small pimples with and without whiteheads can develop.  In both types, the whiteheads and the redness calm down after the flare-up subsides, but in type 1 rosacea, the roadmap-y kind of redness remains for life unless removed with laser.

Rosacea is NOT a type of acne!  There are ways you can tell if you actually have rosacea or if you simply have adult acne.  Find out more!

Then there's type 3 rosacea, also known as Ocular Rosacea, which affects the eyes and is marked by red rims, dry-eye that feels like sand, and ultimatley, bloodshot eyes.  This is only treated with special eye drops obtained from an eye doctor.  Type 4 rosacea, also called Phymatous Rosacea, is the point where untreated rosacea becomes so bad, the skin-swelling and thickening that eventually occurs in all forms of rosacea, plus the accompanying large pores and distending capillaries, make the nose blow up to a large size.  An example is often given of W.C. Fields. 

Rosacea is a vascular disorder, not a skin disorder.  Find out more on the AcneWhisperer Blog!

Rosacea was previously thought to be a skin condition.  In fact, it was thought to be a type of acne, which is why antibiotics were traditionally prescribed to treat symptoms.  

However, it is now understood that rosacea is actually a disorder of a vascular system that has a rather unhealthy relationship with both the nervous and immune systems, so it cannot be addressed by antibiotics alone.  Antibiotics work to control the presence of a mite that is a normal part of skin flora, but is overly abundant in rosacea skin.  The activity of this mite contributes to inflammation of the skin and triggers flareups.  This is why there was a small amount of improvement in my client's condition mentioned at the beginning of this post.  

How do I know I have it?  This breakout looks so much like acne!

One of the primary ways you can distinguish a rosacea flare from an adult acne breakout is that in rosacea there is virtually no presence of blackheads at all, aside from the normal t-zone blackheads most people have.  You will see large pores in rosacea, and sometimes shadows can make you think you see blackheads, but if you look very closely, you'll see those pores are not filled with blackhead material.

Are you sure it's adult acne?  Are you sure it's rosacea?  The difference is blackheads!  Find out more on the AcneWhisperer Blog.

Another difference is that redness you see in an adult acne breakout is only located on blemishes themselves.  With a rosacea breakout, redness surrounds areas around any red bumps.  In addition, these red bumps are mostly of small, even size, whereas acne blemishes are of different sizes.

BEST MASK for rosacea with tiny breakouts, and for inflamed adult acne breakouts!  Calming, mildly exfoliating, soothing, hydrating.  From Daniela's Facial Studio, home of the AcneWhisperer Blog.

With all this in mind, a skincare routine for managing rosacea must focus on calming and soothing the skin, reducing the intensity of blood flow, and reducing the enzyme that triggers oil which is fed on by that pesky mite I mentioned earlier.  In next week's post, I will be laying out a complete regimen for managing rosacea, as well as for redness issues where rosacea is not the problem.

In more severe cases, prescription medications like Oracea, Finacea, Metrogel or Metrocreme, and the new topical form of Ivermectin called Soolantra, are very effective when used in conjunction with a personalized skincare routine, supplements, and lifestyle changes.

What steps can I take if I do have rosacea?

There are a few lifestyle changes to consider:

  • Sun exposure is the biggest rosacea trigger.  You must become obsessive about sunscreen and avoid sun exposure whenever possible.
  • Lower the consumption of alcohol if you find it to be a trigger.  Not everyone does!  Take note of how flushed you get when you drink, and how long it lasts.
  • Not everyone flares up with spicy foods or caffeinated beverages, but if you notice flare-ups, you'll need to cut down, or cut them out completely.
  • Make sure to exercise only in ventilated areas, or out of doors before 10am or after 4pm.
  • Avoid entirely steam rooms and saunas, which also means, so sorry, no hot yoga!
  • Turn down the temperature of your shower.
  • Cover your face for a minute or two between extreme changes in temperature, like going from the cold wind into a warm building.
  • When the heat is on full blast in your car, open the passenger side window just a crack to prevent from getting too much heat on your face.
  • Increase your consumption of dark green leafy vegetables, orange and yellow vegetables, and the pith of citrus fruits, to strengthen capillary walls.
  • Take a Vitamin C supplement that has extra bioflavanoids added.  A great supplement is "Quercetin Complex" from the brand Solgar.

Your adult acne problem has a source, and clearing your skin requires finding that source and either eliminating it or healing it.  You can start right now by filling out my Eval by Email® Online Skincare Consultation Form created specially for ages Gen-Y to Baby Boom!

Adult Acne Solutions custom designed just for you! Eval by Email, Virtual Skincare Coaching specially designed for acne sufferers ages 24 and up.

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  1. You are doing amazing work ❤️! Thanks for sharing your wonderful posts. I am using tretinoin (retin-a) 0.05% for acne / anti ageing but I have rosacea. I’m not using it for rosacea per day, but i am using it to improve redness/ skin health etc so I guess I’m using it for rosacea second to acne. So happy 😊 I googled ‘Ret247get’, and got retin-a. It hasn’t aggravated it so far. I find if I use moisturiser lots it generally has been pretty good for my rosacea, it’s made my skin more healthy, which in turn has improved my redness...

    1. Thank you so much for your comment! :) Just remember, since you're getting it on line and not from a doctor who can monitor you, you need to make sure you're applying correctly - thinly and not too frequently, nowhere near the eyes or mouth, and that you're not only using lots of moisturizer, but lots of sunscreen, too! Apply sunscreen in the morning and then again once in the afternoon if indoors and once every 2-3 hours if outdoors! If you have Type 2 Rosacea, which features pimples with and without white tops, and you had some acne as a teenager, you have a little more oil in your skin than someone who has Type 1. This means you definitely have to consider yourself acne-prone, which means the cream version of Retin-A, which contains a very pore clogging ingredient in its base, will result in acne breakouts down the road. The reason doctors will sometimes prescribe Retin-A for Rosacea, even though exfoliation is supposed to be a complete disaster by making the surface of the skin even more sensitive than it already is, is that while it does thin the top layer of the skin, it also thickens and strengthens the layer underneath. In some cases of rosacea (not all), this can be a very positive thing. Please keep me posted! :)

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