Learn more about the difference between acne and rosacea

Learn more about the difference between acne and rosacea

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.

Types of Acne - Severe to Mild Identification

Types of Acne - Severe to Mild Identification

One of the most common signs of rosacea, bumps and pimples, is also one of the most common causes of confusion about the skin condition. In a recent NRS survey on the progression of rosacea, patients reported the bumps and pimples of subtype 2 (papulopustular) rosacea as one of the top three symptoms of the disorder, after flushing and persistent redness. Thirty percent of respondents said it was the third symptom to appear in their case. Unfortunately, subtype 2 rosacea was historically referred to as “acne rosacea,” reflecting the belief that the two conditions were related. Although it is now known that there is no connection between acne and rosacea, the term can still be found in older literature about the disease, as well as in occasional reports today. This has often led to confusion by the public, and rosacea sufferers with bumps and pimples may mistakenly self-diagnose themselves as having acne. The two disorders require different treatment, however, and acne medications may cause rosacea symptoms to get worse. It is common for patients to experience more than one rosacea subtype and even experience additional skin disorders on top of their rosacea. A general rule of thumb in distinguishing between subtype 2 rosacea and acne vulgaris is that blackheads (comedones) occur only in acne, while only rosacea involves persistent redness and flushing. If you might be experiencing signs of subtype 2 rosacea, the chart below may provide a quick and easy reference to help distinguish between rosacea and acne. See a dermatologist for proper diagnosis and to receive appropriate treatment for your individual case. The four subtypes of rosacea are described here.

Acne and rosacea — two of the most widespread dermatological conditions — can share common features, and accurate diagnosis is especially important because antibiotic resistance is a growing concern worldwide, according to Dr. Hilary Baldwin, associate professor of dermatology at the State University of New York-Brooklyn, in a recent article in the medical journal Cutis. The two disorders may be especially confused when the term "acne rosacea" is used, Dr. Baldwin said. She noted that the phrase was once frequently used to describe what is now known as subtype 2 (papulopustular) rosacea, which may include bumps and pimples that appear similar to acne. However, the distinction between the two prevalent disorders is important to make, she said, because the recent increase in knowledge of their very different mechanisms of action allows better understanding of appropriate therapy, particularly where antibiotics are concerned. Dr. Baldwin noted that while acne and rosacea are clinically and biochemically different, the distinction between the two conditions is often based on a compilation of several broad generalities rather than clear-cut diagnostic criteria. For example, rosacea is a chronic disorder that occurs primarily in the central portion of the face and usually includes redness, flushing and blushing, and bumps (papules) and pimples (pustules). Rosacea can also involve the eyes and even a bulbous nose. Acne is seen most commonly in teens, while rosacea occurs most often much later. Also, unlike in patients with rosacea, blackheads are generally present, and bumps and pimples on the trunk and arms are common, she said. Though both conditions may involve bumps and pimples, the causes and biochemical processes are different for each. Acne is a product of many factors, involving the hair follicles, hormonal stimulation of oil gland cells and bacteria that can be treated with antibiotics. On the other hand, recent research has found that rosacea appears to be linked to a dysfunction of the body's natural immune system, and should thus be treated with medications designed for their anti-inflammatory rather than antibacterial effects. Antibiotic resistance may occur through unnecessary use of antibiotics, allowing disease-causing bacteria to evolve that are able to survive exposure to these medications, thus leading to infections that are difficult to treat. The U.S. Centers for Disease Control and Prevention (CDC) has called antibiotic resistance one of the world's most pressing public health threats, she said. "Therefore, distinguishing between the two conditions is of great importance as we attempt to improve the health of our patients while minimizing ecologic mischief," Dr. Baldwin said, noting that anti-inflammatory therapy specifically for rosacea is now available in both oral and topical forms to help minimize the risk of bacterial resistance. "The time to be cavalier has passed."

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Unfortunately, subtype 2 rosacea was historically referred to as “acne rosacea,” reflecting the belief that the two conditions were related. Although it is now known that there is no connection between acne and rosacea, the term can still be found in older literature about the disease, as well as in occasional reports today. This has often led to confusion by the public, and rosacea sufferers with bumps and pimples may mistakenly self-diagnose themselves as having acne. The two disorders require different treatment, however, and acne medications may cause rosacea symptoms to get worse.

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Couperose skin and Rosacea can appear very similar. The following list represents the differences between Couperose and Rosacea: Couperose skin is usually found on those with very pale complexions living in cold, harsh climates. The skin appears dry and tight and is not inflamed. Meanwhile, Rosacea is marked by excessive inflammation, facial flushing and bumps on the skin. Rosacea may be accompanied by a burning, stinging sensation that is similar to sunburn. The skin may simply feel warm. Couperose skin does not experience this sensation. Skin that is Couperose is not subjected to the acne-like pimples that are found in some cases of Rosacea. Some Rosacea sufferers may experience Couperose skin as a symptom.

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Dr. Baldwin noted that while acne and rosacea are clinically and biochemically different, the distinction between the two conditions is often based on a compilation of several broad generalities rather than clear-cut diagnostic criteria. For example, rosacea is a chronic disorder that occurs primarily in the central portion of the face and usually includes redness, flushing and blushing, and bumps (papules) and pimples (pustules). Rosacea can also involve the eyes and even a bulbous nose. Acne is seen most commonly in teens, while rosacea occurs most often much later. Also, unlike in patients with rosacea, blackheads are generally present, and bumps and pimples on the trunk and arms are common, she said.
It's rosacea, not acneJuly 20, 2015By Lisette HiltonNearly half of rosacea patients thought they had acne before being diagnosed. Learn how to explain the difference between rosacea and acne to patients and help them get the care they need.
Acne may not be particularly dangerous, but it is certainly both unpleasant and very common. Acne typically happens with P. acnes, a type of bacteria that also lives on healthy skin, invades hair follicles, causing irritation and infection. In severe cases, acne is treated with antibiotics. Some of these drugs are applied directly to the skin, and others are taken as a pill. Delivered in pill form, antibiotics travel throughout the entire body, where they can also kill beneficial microbes. Some doctors are beginning to wonder if treating acne this way makes us vulnerable to other illnesses. At the root of acne seems to be an imbalance between acne-causing bacteria and microbes that protect us. A better acne treatment may one day come in the form of a cream that nurtures the healthy microbes that protect our follicles from infection.
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.
Ocular rosacea: When rosacea affects the eye, it is called ocular rosacea. If rosacea affects your eye, you may need to see an ophthalmologist (doctor who specializes in treating eye diseases).
Acne vulgaris and acne rosacea are two commonly confused skin conditions. While it is possible to experience both acne and rosacea simultaneously (and some remedies do help both congruently), it is important to determine your exact skin condition to ensure proper treatment. So, which skin condition is affecting you?
Common treatments for both acne vulgaris and acne rosacea include oral and topical anti-inflammatories and antibiotics. If your acne or rosacea is preventing you from normal activity, it might be time to consult with a dermatologist, who will start you on a treatment plan based on your skin type.
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