Acne Rosacea: What It Is, Comparison to Acne, Symptoms and Treatments

• Acne rosacea is one of four types of rosacea, a chronic inflammatory skin condition that typically develops during adulthood.
• Symptoms concentrate around the cheeks and nose, and consist of persistent sensitivity, redness, irritation and breakouts similar to acne.
• Treatment typically requires a combination of topicals, antibiotics and a carefully structured skin care regimen.

Acne rosacea (also known as papulopustular rosacea) is a form of rosacea that causes acne-like symptoms during flare-ups. Although considered a chronic condition, symptoms come and go, with periodic outbreaks brought on by specific triggers.

It is not fully understood why acne-like symptoms accompany this form of rosacea. The symptoms are believed to be brought on by the inflammation that occurs with flare-ups, which can be triggered by heat, stress or certain medications. This inflammation causes facial pores to swell and fill with pus in a manner resembling an inflammatory acne outbreak.

Treatments for acne rosacea include medicated topical creams and ointments, as well as oral antibiotics that reduce inflammation.

What Is Acne Rosacea?

Rosacea is an inflammatory skin disorder that causes a red rash to appear on the face. It is typically concentrated around the nose and cheeks, but has also been known to affect the eyes.

Acne rosacea is a subtype of rosacea that causes the appearance of inflamed, red bumps known as papules and pustules in addition to flushed skin. Pustules are papules that become swollen with bacteria and white blood cells, which degrade and cause white pus to form

Causes of acne rosacea

The underlying causes of the different forms of rosacea aren’t entirely understood, but several contributing factors are thought to come into play. 

One possible cause is a genetic abnormality that causes the blood vessels in the face to become more dilated than normal. This makes the facial skin more prone to flushing in response to triggers such as alcohol, spicy foods and extreme heat or cold.

Rosacea flare-ups may also be due to an abnormal immune system response to toxins or allergens, which causes excessive inflammation and flushing in the face.

Another potential cause of acne rosacea is an overabundance of tiny mites, known as Demodex, in the hair follicles on the face. These mites are normally found on healthy human skin, however those with acne rosacea carry a disproportionately high amount, which is associated with irritation and inflammation.

Is acne rosacea the same as rosacea?

Acne rosacea is one of the four forms of rosacea. All four are similar in their causes, triggers and symptoms, but have certain differences that make them distinct.

• Erythematotelangiectatic rosacea (ETR) flare-ups leave skin flushed, red and irritated, and often lead to broken capillaries. As such, they are accompanied by the appearance of visible vascular markings.
• Rhinophyma is a less common form of rosacea and is marked by thickened, swollen and bumpy skin. Rhinophyma affects the nose and more commonly affects men.
• Ocular rosacea causes irritation in the eyes, making them appear bloodshot and watery. Severe cases are marked by the formation of cysts on the eyelids, which cause a stinging and burning sensation.

How Does Acne Rosacea Differ from Acne Vulgaris?

Papules and pustules (more commonly known as pimples) are common symptoms of both types of acne, which can make these two conditions difficult to distinguish.

The key difference is that the papules and pustules formed by acne rosacea do not contain comedones. These are the tiny clogs made from buildups of dirt, oil and dead skin cells that are at the center of acne vulgaris formation.

In the case of acne vulgaris, inflamed lesions are formed when clogged pores become colonized by bacteria such as Cutibacterium acnes (formerly Propionibacterium acnes). For acne rosacea, the papule and pustule formation is triggered by the inflammatory response that accompanies flare-ups.

Who gets it?

Acne rosacea can develop in anyone regardless of their age, sex or ethnicity, however statistics show that it more commonly develops among adults, and is slightly more prevalent among women than men. Women going through menopause are particularly susceptible.

Rosacea is commonly believed to be more prevalent in those with lighter skin tones. However, studies suggest this may be due to the fact that rosacea is more difficult to detect on darker skin.

Symptoms

Although these conditions share several common symptoms, they differ significantly in their respective range of possible symptoms, the area of skin affected and the time of life at which they first appear.

	Acne Rosacea	Acne Vulgaris
Symptoms	Development of dry, red, inflamed patches of skin; pustules and papules	Development of comedonal acne (blackheads and whiteheads),pustules, papules, cysts and nodules depending on severity
Area affected	Symptoms are concentrated around the cheeks and nose	Symptoms appear over entire face, and sometimes on other areas of the body, such as the back
Period of onset	Typically develops well into adulthood	Typically develops during adolescence

How to Treat Acne Rosacea

Acne rosacea is most effectively treated by combination therapy that includes both topical and oral medication. In more extreme cases, aesthetic procedures may also be necessary to effectively eliminate symptoms.

Treatments for acne rosacea and acne vulgaris sometimes overlap, but because they are fundamentally different conditions, there are some distinct differences. 

Topical medications

Topical creams and ointments are a moderately effective treatment option for acne rosacea. They can provide fast relief from common symptoms including irritation, redness and stinging. Some topicals are available over the counter, while others require a prescription.

• Azelaic acid is proven to safely and effectively reduce the swelling and redness associated with rosacea. This medication may cause a minor tingling or stinging sensation when it is first applied to the skin, but this will subside over time.
• Metronidazole has been found to effectively reduce inflammatory lesions associated with rosacea. It is, however, known to cause skin dryness, irritation and a stinging sensation.
• Tretinoin (Retin-A), is a powerful retinoid topical available only through prescription. It is highly effective in reducing inflammation. However, it also causes photosensitivity, and may make the skin more prone to rosacea flare-ups triggered by sun exposure.

Oral medication

Antibiotics and other oral medications function similarly to most topical medications – by killing bacteria and reducing inflammation. Some effective oral medications include:

• Tetracycline
• Minocycline 
• Doxycycline (in low doses, this will only provide mild anti-inflammatory effects)
• Erythromycin 
• Isotretinoin (a strong medication with serious side effects, which should not be taken by pregnant women) 

Oral antibiotics should be taken with food, but not alongside dairy products. This is because the calcium in milk products binds with antibiotics and neutralizes their effects.

Antibiotics will also gradually lose effectiveness after a few months of use, as the body will eventually grow resistant to them.

Aesthetic procedures

Nonpharmacological therapies may prove necessary if oral medications and topical treatments do not succeed in clearing the skin. However, these treatments are rarely covered by insurance, and may cost hundreds of dollars.

Laser therapy reduces the red patches associated with acne rosacea. It functions by targeting and destroying the broken capillaries responsible for the red appearance. Laser procedures have a low risk of scarring and serious side effects but may cause irritation and photosensitivity. A waiting period of a few days to a few weeks is required between sessions. 

Intense pulsed light (IPL) therapy works similarly to laser therapy, but uses a mixture of different wavelengths of light. This form of treatment has an even lower risk of side effects than laser procedures and requires less wait time between appointments. However, more appointments are typically needed for greater results to appear.

How to treat acne vulgaris

Some acne rosacea treatments, such as tretinoin, are also effective in treating acne vulgaris. Benzoyl peroxide is another effective topical acne medication that kills bacteria and helps to clear clogged pores.

Laser and IPL treatments, as well as skin resurfacing procedures such as dermabrasion, are also effective in reducing acne severity.

Treating breakouts as early as possible will help to reduce the risk of permanent scarring, as well as decrease the chances of the acne spreading to other areas of the face. 

Prevention

You can avoid acne rosacea flare-ups by staying clear of common rosacea triggers, such as sun exposure, extreme heat and cold, wind or humidity. If sun exposure cannot be avoided, be sure to wear sunscreen and wide-brimmed hats when outdoors.

Other common rosacea triggers you may wish to avoid include alcohol consumption, hot baths, strenuous exercise, emotional stress, spicy food and hot beverages.

Skin care products containing alcohol, menthol and eucalyptus oil should also be avoided, as these can irritate the skin and prompt an inflammatory response. Instead, opt for gentle cleansers containing moisture-boosting ingredients such as aloe and hyaluronic acid.

Takeaway

Acne rosacea is a form of rosacea that includes papules and pustules as one of its symptoms. Unlike acne vulgaris, acne rosacea formation begins with the inflammatory response of rosacea, rather than developing inside clogged pores. It is also almost always focused around the nose and cheeks, and commonly appears during mid-adulthood instead of during adolescence.

The causes of these conditions are also different. Rosacea is rooted primarily in the condition of the blood vessels and immune system. Conversely, acne is primarily caused by clogged pores, which develop due to excessive sebum production and the buildup of dead skin cells and dirt on the surface skin.

Treatments for these conditions often overlap, but those for acne rosacea focus primarily on reducing inflammation and irritation, while those for acne vulgaris will focus on cleansing pores. Avoiding common triggers for rosacea will also significantly reduce your risk of flare-ups.