Rosacea vs. acne: What’s the difference?

Rosacea and acne are two skin conditions that appear to have a lot in common. They both tend to affect your face, and they both involve inflammation in your skin. However, these are different conditions with several key differences.

The two conditions differ in their causes, symptoms, and treatments. Knowing which one is affecting you can help you get the right diagnosis and treatment.

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What is rosacea?

Rosacea is a common skin condition affecting more than 5% of people worldwide. Its symptoms are caused by inflammation, which leads to flushing, discoloration, and pustules on your face that look like pimples. It can also cause your skin to thicken, particularly across your nose.

Rosacea usually happens in flares, which means your symptoms may lessen for a short time before worsening again, usually in response to a trigger.

Causes

Experts aren’t sure exactly what causes rosacea, but it’s likely due to a mixture of genetics and environmental factors. For example, 2023 research identified several specific genes associated with the condition and suggested that, in many cases, it’s likely inherited from family members with the condition.

Some environmental factors that might cause rosacea include bacteria or tiny Demodex mites that naturally inhabit your skin, known as the skin microbiome, and ultraviolet (UV) light exposure.

Although the root cause of rosacea is unclear, several triggers are known to cause a flare-up of symptoms. These include:

• sunlight exposure
• periods of high stress
• certain foods, especially spicy foods
• alcohol consumption, especially red wine
• cosmetics like skin care products or makeup
• hot or cold temperatures
• windy conditions
• exercise

Treatments

There is currently no cure for rosacea, but several treatments aim to soothe discomfort, reduce symptoms, and prevent the condition from worsening. A treatment plan might include topical medications, oral medications, or medical procedures:

• Topical medications: Some medications can be applied directly to your face. These include brimonidine gel (Mirvaso), metronidazole gel (Metrogel), and azelaic acid (Finacea). Doctors might also prescribe topical ivermectin (Soolantra).
• Oral medications: In more severe cases, doctors might prescribe oral antibiotics like doxycycline (Oracea). They might also try oral isotretinoin (Absorica).
• Medical procedures: In some cases, doctors might recommend procedures like laser resurfacing, which uses a laser directed at the affected area, to manage symptoms. Doctors might also use a scalpel to remove excess thickened skin tissue.

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What is acne?

Acne is a common condition, particularly among adolescents. It’s a skin condition that causes inflammation and painful breakouts of pimples, most often on your face. It usually happens when your pores are clogged with oil, dead skin cells, or bacteria.

Causes

The main cause of acne is clogged pores. There are many reasons why your pores might become clogged. For example, acne is more common during adolescence because of the increase in hormones called androgens, which increases sebum (oil) production, leading to clogged pores.

In some cases, bacteria can cause acne. Some kinds of bacteria typically inhabit your skin, but in some cases they may overgrow and irritate your skin, causing acne.

You also might be more likely to develop acne if you have a close family member who has had the condition, especially if it is severe.

Acne also has certain triggers that may worsen the condition or cause it to flare up. These include:

• diet, including if you eat a lot of processed, sugary foods or dairy
• stress
• oily cosmetics like makeup
• cigarette smoking
• exercise and sweating

Treatment

Acne can generally be successfully managed with over-the-counter (OTC) and home remedies, with prescription medications used in severe cases. In milder cases, only OTC and self-care remedies will be sufficient. These include:

• Retinoids: Retinoids are molecules that come from vitamin A. Mild versions are available OTC to help with skin conditions. You can use retinol and adapalene (Differin) to manage acne.
• Azelaic acid: Azelaic acid (Finacea) may help manage your symptoms and fade scarring.
• Benzoyl peroxide: Many OTC acne products contain benzoyl peroxide (Enzoclear) as their active ingredient, starting at around 2.5% strength.
• Salicylic acid: Salicylic acid is another common ingredient in OTC acne products like cleansers or creams. It can help unclog your pores.

If your acne is severe, doctors might prescribe oral isotretinoin (Absorica). This is a strong vitamin A retinoid, and doctors mostly recommend it for very severe or recurrent acne.

Doctors might also prescribe topical antibiotics like clindamycin 1% (Cleocin), doxycycline (Oracea), or erythromycin 2% (Erythrocin) for their anti-inflammatory effects.

Some self-care remedies to help soothe your symptoms include:

• using mild, acne-friendly skin care and makeup products
• keeping your skin clean using a mild cleanser
• not touching or squeezing pimples
• using lukewarm water when showering or cleansing

Can you have both?

It is possible to have both rosacea and acne at the same time. Their symptoms can overlap, which may mean you’re diagnosed with only one condition. However, treatment might not be completely effective if you only target one condition.

A subtype of rosacea, known as papulopustular rosacea, can mimic the symptoms of acne. It also has pus-filled pimples and red or discolored bumps. However, acne treatments are unlikely to be effective for this form.

Key differences

Acne and rosacea have many similarities. They’re both skin conditions that largely affect your face, causing bumps and discoloration, and they’re both triggered by external factors. However, they’re still different conditions, and there are several ways to tell them apart:

• Symptoms: Some symptoms may overlap, but rosacea is more likely to cause thickened skin and flushing, whereas acne is more likely to cause pimples and whiteheads.
• Affected population: Acne most often affects adolescents, whereas rosacea is more common in adults ages 30 to 60.
• Treatments: Laser resurfacing can be used for rosacea, alongside prescription creams. OTC and self-care remedies are often sufficient for mild acne.
• Triggers: Both conditions have certain triggers that may worsen symptoms, but rosacea triggers include exercise, alcohol consumption, and weather changes, whereas acne is likely triggered by oily skin care products.

Online care for rosacea or acne

Acne and rosacea are similar conditions that may be easily confused with one another. It’s important to seek the right diagnosis and treatment to manage the condition you have.

Online care services, including Optum Perks Online Care, may make getting treatment easier. With these services, you can submit an online form answering a few questions about your symptoms, and a US-licensed healthcare professional will respond soon after to prescribe a treatment plan.

Summary

Acne and rosacea are very similar conditions that both affect the skin on your face. However, they have many key differences that distinguish them.

Rosacea most often affects middle-aged adults. It causes thickened skin and flushing of the face. Acne, on the other hand, most often affects adolescents and causes breakouts of pimples. The two conditions also have different treatments, so it’s important to speak with a doctor for an accurate diagnosis.

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