The first step to finding an effective treatment is knowing what you’re up against. If you’re unsure if those red bumps on your face are acne, rosacea, or a little of both, here’s how to figure it out.
Take a closer look at your bumps.
Even though for many people rosacea is characterized by a red flush, it can also present with bumps in addition to redness. In fact, the most common subtype of rosacea—type 2, or papulopustular type—causes painful, red bumps that look a lot like acne.
So how do you distinguish the two? “The main distinguishing feature between acne and rosacea would be comedones, [which] are very specific for acne,” Jennifer Manusco, M.D., a dermatologist at the University of Michigan, tells SELF. Comedones, which may be open or closed, are visibly clogged pores that aren’t inflamed (meaning they aren’t red, swollen, or painful).
An open comedone is essentially a blackhead, meaning it’s a pore filled with a small black dot, John G. Zampella, M.D., assistant professor in the Ronald O. Perelman department of dermatology at NYU Langone Health, tells SELF. A closed comedone, on the other hand, will “be white in the middle and you’ll have a thin layer of skin over the top,” he says. If you have lots of open and/or closed comedones, you’re likely dealing with acne.
If you have bumps that are inflamed—like papules, pustules, nodules, or cysts—it gets a little trickier to figure out exactly what condition you’re dealing with because bumps like these are a feature of both acne and rosacea.
If you have inflammatory acne, for instance, an overgrowth of bacteria causes comedones to swell, eventually turning into a big, red, pus-filled cyst. And with rosacea, the condition’s characteristic inflammatory response can cause (or worsen) irritation, leading to swollen red bumps.
Get to know your triggers.
If you’ve inspected your bumps and are still confused, try to identify patterns and triggers: when and where do your bumps appear?
Rosacea triggers tend to vary by individual, Dr. Manusco says, but they usually include factors like sunlight, heat, cold, stress, strong emotions, alcohol, hot beverages, and spicy foods. Because rosacea can also lead to sensitive skin, you may notice that certain harsh skin-care products (like acids, acne treatments, or retinoids) cause flare-ups as well.
Acne, on the other hand, is commonly triggered by hormonal fluctuations, which is why it often occurs during puberty, menstruation, pregnancy, and menopause. “Some medications can cause acne, too,” Dr. Manusco says, “[like] certain types of birth control pills or IUDs, steroids, and some bipolar disorder medications.” (On the other hand, some people notice their acne gets better with hormonal birth control.) Hormone-replacement therapy can also cause acne, particularly if it involves testosterone.
A good rule of thumb to remember is that, for the most part, rosacea is triggered externally and acne is triggered internally. If your flare-ups happen after a run in cold, windy weather, or when you drink coffee, for instance, it’s probably rosacea; if they happen around your period or after a medication change, it’s probably acne.
But there are a couple other factors at play, too, including your age. Acne usually first occurs in puberty or early adulthood, but rosacea is more often diagnosed after 30. Where you get breakouts can also be telling: Rosacea usually affects the center of the face—cheeks, chin, forehead, nose—but acne can appear anywhere on your face or body.
Of course, these general rules are not black and white. It’s also possible to have both acne and rosacea, which can just make all of this more confusing, and why you should also seek out a dermatologist for an accurate diagnosis.
There’s a lot of overlap with treatments.
If some of your symptoms point to rosacea and others point to acne, don’t worry. Even though telling these conditions apart can be tricky, Dr. Zampella emphasizes that “the difference might not be all that important because the treatment(s) might be the same.” In other words, don’t be surprised if you have rosacea and your derm recommends or prescribes something you commonly think of as an acne treatment.
For instance, Dr. Manusco and Dr. Zampella both recommend azelaic acid for people dealing with acne and rosacea, which comes in prescription and over-the-counter formulas. Although it’s an acid, it usually doesn’t cause too much irritation, as SELF wrote previously.
For some people, benzoyl peroxide and retinoids also function as treatments for both rosacea and acne. However, these options often cause irritation and worsen symptoms at first, especially in people with sensitive skin caused by rosacea—so it’s best to consult a dermatologist before trying one of these.
Antibiotics are great at reducing inflammation, which is why dermatologists may prescribe them for acne or rosacea. Topical antibiotics like clindamycin or metronidazole can calm mild surface redness, while oral antibiotics (usually doxycycline) reduce inflammation from within. Some people with acne or acne-like rosacea symptoms may also benefit from using topical treatments containing sulfur or sodium sulfacetamide, the AAD says.
In addition to treatments like these, you may be able to manage your flare-ups by adjusting your behaviors so that you minimize exposure to your triggers. Your dermatologist can help you track your flare-ups, figure out what’s causing them, and recommend gentle skin-care products that are less likely to irritate sensitive skin.
Ultimately, there’s a pretty wide variety of over-the-counter and prescription skin-care treatments that address these issues, some of which may be better suited for acne or rosacea, and some that may work well for both. Like with any skin condition, treatment can be very subjective, so it’s important to work with your dermatologist to get a proper diagnosis and determine what treatment plan makes the most sense for you.
Don’t forget, patience is key.
As usual with skin products and treatments, you’re not likely to see immediate results. And, unfortunately, things may get worse before they get better. “Some products, particularly topical retinoids and benzoyl peroxide, can irritate and may temporarily worsen acne and even rosacea,” Dr. Manusco explains. “But if you persist treatment, you can see improvement.”
That’s why she recommends sticking with those treatments for at least three months—despite mild flare-ups. It’s also important (always, but especially if you’re dealing with sensitive skin) not to use too many potentially irritating products at once. Instead, give each new product at least a few weeks to work on its own before deciding to drop it or add something else to your routine.
But if you’re not seeing any improvements after consistently using the product for a few weeks, or you feel like you’re actually breaking out more, it’s time to check in again with your dermatologist.
At the end of the day, it’s all about pinpointing the skin issue you have and finding what works for you. Be patient, stick with treatment, and keep an open mind. Chances are an effective treatment plan is out there, just waiting for you to find it.
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