Click Here To Schedule A Consultation

Schedule a Consultation

  • This field is for validation purposes and should be left unchanged.

Dr. Michele Green, based on the Upper East Side of NYC, is an internationally renowned expert in cosmetic dermatology, and in particular skin conditions such as acne rosacea. When it comes to our skin, little red bumps can develop for a variety of reasons. Two of the most common skin conditions that cause red bumps and blemishes or raised pimples are acne vulgaris and rosacea. Though rosacea has several different subtypes, many rosacea patients have to deal with acne-like breakouts whenever they experience a rosacea flare-up. Rosacea and adult acne, are two of the most common conditions that Dr. Michele Green treats in her Manhattan, private, New York dermatology office.

One of the most difficult aspects for a patient with inflammation, facial redness, or sensitive skin is to know how to treat these pimples and papules on the surface of the skin. Rosacea flare-ups can manifest itself as a simple acne breakout, or develop into papulopustular rosacea, ocular rosacea, or if untreated can develop into rhinophyma. Understanding the underlying cause of any red bumps on the skin is essential in determining which treatment options are best to restore healthy, clear skin.

If you’re suffering with pustules and acne-like breakouts, or from inflammation or facial redness, board-certified dermatologist Dr. Michele Green in NYC is here to help. Dr. Green is an expert in cosmetic dermatology, with over two decades of treating patients with acne, rosacea, acne scars, sensitive skin, and will help determine the cause and best treatment for you. She will help select the right skin care regiment, oral and topical treatment, and any cosmetic treatments necessary to improve your acne rosacea. Whether it be VBeam® laser treatment to remove blood vessels, telangiectasis, and facial redness, HydraFacials to exfoliate clogged pores, or chemical peels to replenish the skin, Dr. Green will guide you to rejuvenate and maintain beautiful, healthy skin.

MG 19 before after accutane acne 1 to 5months MGWatermark

Accutane for Acne, 1 and 5 months before and after

Do I have rosacea or acne?

When assessing whether a patient is dealing with acne or acne rosacea, it is important to consult a board certified dermatologist, like Dr. Michele Green in NYC. There are many ways in which skin diseases, such as acne, develops. Acne typically develops due to a variety of genetic factors, and is caused by a combination of the body’s natural oil production, bacteria on the surface of the skin, and dead skin cells that can clog pores and create blemishes. Rosacea, although also linked to genetics, can be exacerbated by a variety of environmental factors. The first signs of rosacea typically develop as redness or itchiness on the surface of the skin with prominent blood vessels. There are four main subtypes of rosacea:

Subtype 1: Eurerythematotelangiectatic rosacea

Subtype one is defined by erythema (facial redness), flushing, and visible small blood vessels.

Subtype 2: Papulopustular rosacea

Subtype two is marked by acne-like breakouts and a characteristic inflammatory response on the surface of the skin. This is the most common form of rosacea, and is also referred to as acne rosacea.

Subtype 3: Rhymatous rosacea

Subtype three, also commonly referred to as rhinophyma, is a rare type of rosacea where the facial skin thickens, and most commonly happens on the nose. Characteristically W.C. Fields was thought to have rhinophyma, which can develop when rosacea is not kept under control.

Subtype 4: Ocular rosacea

Subtype four is identified by characteristic irritated eyes, redness around the eyes, and/or swollen eyelids. Patients may develop scales and crusts on the eyelashes, which can be misdiagnosed as seborrheic dermatitis. Additionally, patients may see symptoms and think they are dealing with styes, when in fact they are dealing with ocular rosacea.

LL 35 44 before after thermage and injectables jan 2018 ANGLEL 1 MGwatermark

Female treated with VBeam and Thermage

What are common Rosacea acne triggers?

For many patients dealing with cases of rosacea, it can be useful to highlight rosacea triggers or environmental factors that may be causing a flare-up. One of the main differences between acne rosacea and traditional acne is the factors that can lead to a flare-up or breakout. When it comes to traditional acne lesions, the skin tends to experience a breakout during hormonal shifts, or when a major medication or skincare routine has shifted (i.e. not washing up immediately after exercise, using a pore-clogging moisturizer, etc.).

While acne is often caused by changes in the body, rosacea is typically triggered by certain irritants. According to The National Rosacea Society, these triggers can be environmental factors, such as extreme temperatures, sun exposure, emotional stress, irritation from coronavirus face masks, or dietary triggers such as alcohol, hot beverages, or spicy foods. The condition may also be linked to genetics, meaning those with a family history of rosacea are more likely to develop symptoms. Additionally, patients who are dealing with acne rosacea may experience further skin irritation when using harsh skincare products or cleansers, such as those that rely on retinol or certain acids.

Though many of these triggers are associated with the onset of a rosacea flare-up, there are also factors that can make your rosacea symptoms worse. These include the skin mite, demodex folliculorum, which carries the bacterium Bacillus oleronius, the gut bacteria Helicobacter pylori (commonly referred to as h. pylori), and the protein cathelicidin, which is typically used by the body to protect the skin from infection.

Symptoms of rosacea versus acne

Acne is typically characterized by papules, pustules, pimples, comedones, and facial cysts. While rosacea can be accompanied by pimples, it does not generally present as comedones, also seen as blackheads and whiteheads. Comedones typically are caused by debris and oil which are trapped within facial pores. Patients who observe small black or white dots at the center of a pore or red bump are typically dealing with acne lesions, rather than rosacea.

For patients who are dealing with subtype 2 of rosacea, the clinical presentation of rosacea can appear very similar to that of traditional acne vulgaris breakouts. Rosacea flares typically present with pustules, redness, oily skin, sensitive skin, raised patches, facial telangiectasias and broken blood vessels. The symptoms and presentation of both acne and rosacea are similar, and so are the treatments involved for each.

Does rosacea cause acne?

Acne rosacea is named for its common symptom: raised red pumps and pustules on the surface of the skin. Though acne rosacea does not spark traditional acne, it absolutely can create red bumps on the skin, sometimes filled with pus, that sure look similar to ordinary acne lesions. In some cases, acne vulgaris can lead to infections deep under the surface of the skin, creating large red bumps or cysts. In severe cases of rosacea, inflammation and irritation can lead to raised bumps that look quite similar to cystic acne, and this can make it difficult for patients to determine what exactly is going on with their skin. When you work with Dr. Green, she’ll be able to both examine your current skin condition, review your medical history and daily patterns to determine the best treatment options for your acne rosacea.

What are the causes of acne rosacea?

The cause of rosacea is not always clear, as rosacea is typically triggered by environmental factors that will lead to an onset of rosacea symptoms. However, there are some common risk factors that may increase the likelihood of developing rosacea. Age tends to be a common factor, with most cases of rosacea affecting patients between the age of 30 and 50. Additionally, patients with fair skin are most commonly affected, women are more likely to have rosacea than men, and those with Scandinavian or Celtic ancestry have an increased risk of developing rosacea.

What are common Rosacea acne triggers?

For many patients dealing with cases of rosacea, it can be useful to highlight rosacea triggers or environmental factors that may be causing a flare-up. One of the main differences between acne rosacea and traditional acne is the factors that can lead to a flare-up or breakout. When it comes to traditional acne lesions, the skin tends to experience a breakout during hormonal shifts, or when a major medication or skincare routine has shifted (i.e. not washing up immediately after exercise, using a pore-clogging moisturizer, etc.).

While acne is often caused by changes in the body, rosacea is typically triggered by certain irritants. According to The National Rosacea Society, these triggers can be environmental factors, such as extreme temperatures, sun exposure, emotional stress, irritation from coronavirus face masks, or dietary triggers such as alcohol, hot beverages, or spicy foods. The condition may also be linked to genetics, meaning those with a family history of rosacea are more likely to develop symptoms. Additionally, patients who are dealing with acne rosacea may experience further skin irritation when using harsh skincare products or cleansers, such as those that rely on retinol or certain acids.

Though many of these triggers are associated with the onset of a rosacea flare-up, there are also factors that can make your rosacea symptoms worse. These include the skin mite, demodex folliculorum, which carries the bacterium Bacillus oleronius, the gut bacteria Helicobacter pylori (commonly referred to as h. pylori), and the protein cathelicidin, which is typically used by the body to protect the skin from infection.

Rosacea with cystic acne

In severe cases of acne rosacea, the inflammation and irritation of the skin can lead to large, painful red bumps that look similar to cystic acne lesions. As rosacea is an inflammatory response on the surface of the skin, it tends to have larger areas of redness and raised patches surrounding a protruding pimple. However, in some cases, patients may be dealing with both rosacea and acne vulgaris, which must be treated very carefully so as to prevent irritation and further infection.

If you think you may have severe acne rosacea or cystic acne, it is important to seek treatment from an expert health care professional. Dr. Green has an extensive knowledge of the different types of skin conditions and can work with you to develop a treatment plan that will heal your skin and lower the risk for unwanted side effects such as acne scars.

Rhinophyma

For patients who are dealing with raised bumps on the nose, this may be a symptom of acne rosacea or rhinophyma, rosacea subtype three. Rhinophyma is a rare form of rosacea that typically centers around the nose, leading to redness, thickened facial skin, and bumps. This form of rosacea is thought to stem from cases of severe rosacea that are left untreated, and is particularly common in men 50 to 70 years of age.

md acne 8m front MGwatermark 1

Female treated for acne – 8 months before and after

How to heal rosacea acne

Though rosacea is a chronic skin condition that can often flare-up and fade in cycles, there are a variety of ways that rosacea can effectively be treated. Typically, patients will use a combination of photodynamic treatments, laser treatments, medications, and skincare products in order to reduce the appearance of rosacea symptoms.

When treating rosacea, Dr. Green emphasizes the treatment of three major factors: inflammation of the skin, the appearance of flushed skin or redness, and the restoration of healthy, glowing skin. Dr. Green feels that patients dealing with rosacea should be able to leave her office with healthier, happier skin than before the initial onset of symptoms, and works carefully with each patient to highlight potential triggers or irritants to the skin moving forward.

Acne rosacea topical skincare treatments

First and foremost, it’s important that patients with rosacea use gentle cleansers and non-comedogenic, oil-free moisturizers. Additionally, as sun exposure is a common trigger for many rosacea patients, Dr. Green always recommends using a daily, high-SPF sunscreen or SPF-moisturizer. From there, Dr. Green typically prescribes specific topical antibiotics and treatments to apply for a treatment course. These treatment options include:

  • Azelaic acid– is a gel that treats the papule, pustules, and inflammatory component of rosacea
  • Metrogel®, or Metronidazole, a standard rosacea antibiotic medication that prevents and treats facial rosacea and redness
  • Mirvaso® (Brimonidine) gel, a topical, once-daily medication that narrows blood vessels to reduce redness from rosacea
  • Soolantra® (Ivermectin), an excellent option to treat the inflammatory and erythema components of rosacea
  • Vitamin C Serum, an excellent antioxidant that reduces facial redness, rejuvenates the face, and is available online here.

Does retinol help acne rosacea?

If you’re curious, can retinol help rosacea?, the answer may surprise you. Though retinol, a vitamin-A derived serum commonly used to boost cell turnover on the skin, is commonly used to treat acne, it can frequently make an acne rosacea flare-up even worse. However, for patients who are currently experiencing clear skin, retinol and retinoids can actually help to prevent future flare-ups, according to the American Academy of Dermatology. Nevertheless, as retinol does not work well for everyone, and can worsen active rosacea symptoms, it’s best to work closely with Dr. Green to determine if this skincare option is right for you.

28 male vbeam before after FRONT MGwatermark 1

Male treated with VBeam for Rosacea

What does Rosacea acne look like?

Rosacea acne is characterized by redness or flushing accompanied by small bumps or swelling that resemble an acne breakout. Most commonly, Rosacea acne is found on the center of the face, including the bridge of the nose and the cheeks, the forehead, and chin. Rosacea acne, also known as papulopustular rosacea is one type of rosacea that can develop, which is associated specifically with the development of swelling akin to an acne breakout. Patients may also experience erythematotelangiectatic rosacea, which is characterized by flushing and visible blood vessels – also known as the condition referred to as telangiectasias. The redness on the face can resemble a sunburn or blushing and can feel itchy. More advanced cases of rosacea may cause the skin to thicken, which is called rymatous rosacea. Some patients may experience another type of rosacea that manifests as eye problems, known as ocular rosacea, which causes redness and irritation in and round the eye.

Where does Rosacea acne come from?

The exact cause of Rosacea in patients is up for debate and scientists have not yet definitively determined that suspected risk factors will always lead to a rosacea acne outbreak. However, there are certain risk factors that have been shown to correlate with rosacea acne outbreaks, for example, having a family history of rosacea makes the development of rosacea more likely. Additionally, some patients who experience rosacea have higher densities of certain mites, including demodex folliculorum, which lives on the surface of the skin, or the intestinal bug H pylori. While the exact cause of the condition is not yet known for certain, there are many potential environmental and biological factors that can cause acne rosacea to flare up, including sudden exposure to heat, such as sunlight or a hot bath, alcohol consumption, stress or anxiety, the cold, spicy foods, and some medications, such as certain blood pressure medication. Patients can help to reduce the likelihood of a rosacea flare up by avoiding their triggers.

Can thyroid problems cause acne rosacea?

There are many factors that can lead to a flare up of rosacea and research has demonstrated that thyroid conditions, such as hypothyroidism, may occur at the same time in patients with rosacea. Hypothyroidism is a condition in which the thyroid is not producing enough thyroid hormones, which can lead to fatigue, mood swings, and weight gain. According to published research, there could be a co-morbidity between rosacea and hypothyroidism. Other studies have also shown that rosacea may be linked to an increased production of thyroid autoantibodies, which are antibodies that erroneously target one’s own tissues. As such, there is evidence to suggest that thyroid problems can often be apparent in patients experiencing rosacea.

Why is my rosacea getting worse?

There are many triggers that can cause rosacea to flare up and when left untreated, the condition can worsen over time. Trigger for a flare up my differ from person to person, however, common triggers can include environmental conditions, such as being too hot or too cold, which can be triggered by sunlight, a hot bath, or cold wind, certain types of food or drink, such as alcohol or spicy foods, and emotional states, such as high stress or anxiety.

Certain skincare products, including some make up or hair care products, can cause irritation and a flare up of rosacea as well. Further, a misinterpretation of rosacea as acne can also cause the condition to worsen if patients buy over the counter acne treatment and apply it to the affected area. Acne treatment products can contain ingredients that irritate the rosacea condition causing it to worsen. For that reason, it is important to get a diagnosis and prescription from a board-certified dermatologist, such as Dr. Green.

SG 27 2 month Before and After VBEAM 4 sessions LEFT MGWatermark

VBeam – 2 months before and after

How to clear up rosacea breakouts

A wide range of treatment options available for rosacea breakouts available at Dr. Green’s dermatology office. The first step will be to book a consultation appointment with Dr. Green. There, she will assess your condition and make a recommendation about the treatment plan that will best meet your needs. Treatment plans can include in-office treatments, such as the VBeam pulsed laser to reduce redness and telangiectasia, intense pulsed light therapy, which can decrease spider veins and the flushed appearance of the skin, and photodynamic therapy to address the acne-like outbreak. Dr. Green may also prescribe oral medication, such as the antibiotics tetracycline, minocycline, doxycycline, or erythromycin, or topical medications that contain azelaic acid, metronidazole, or sodium sulfacetamide. When determining the best treatment plan for you, Dr. Green will take into account your current condition and personal aesthetic goals.

Does acne rosacea ever go away?

When left untreated, rosacea often gets worse instead of better. Rosacea can advance such that the symptoms go beyond flushing, redness, and bumps on the surface of the skin. Advanced cases of rosacea can lead to thickened skin. Luckily there are many ways to treat rosacea acne and a wide variety of options are available at Dr. Green’s NYC dermatology office, including in-office treatments, such as laser treatment, intense pulsed light therapy, and photodynamic therapy, and oral medications, such as doxycycline, minocycline, or tetracycline.

cp 21 accutane MGWatermark V2 FRONT

Female treated for acne with Accutane: 5 months

In-office acne rosacea treatment options

When it comes to in-office acne rosacea treatment options, Dr. Green offers a myriad of photodynamic and laser therapies that can help to sooth and smooth the appearance of the skin without the need for downtime. The VBeam Pulsed Dye laser is one of the most popular rosacea treatment options, as it’s able to remove redness and visible blood vessels quickly and effectively. Additionally, the VBeam laser is able to shrink the size of blood vessels, which can prevent further redness from developing. Dr. Green also offers the Sciton Intense Pulsed Light therapy for rosacea, which can be used to reduce the appearance of redness, broken blood vessels, and pigmentation on the surface of the skin.

Photodynamic therapy uses a photosensitizing molecule that is combined with the application of intense blue light to heal and soothe the skin. This treatment is an excellent option for patients with active acne lesions, rosacea, and psoriasis, among other skin conditions. Another light treatment that can be highly effective is that of Red and Blue Light Therapy, which is a form of LED light therapy that can reduce redness, as well as fine lines and wrinkles form the surface of the skin.

Light therapy can be a complementary treatment with Hydrafacials, a medical-grade facial that uses a three-step process of cleansing, exfoliating, and infusing of nourishing serums in order to repair the skin and reduce the appearance of rosacea. For patients struggling with rosacea, Dr. Green applies Rozatrol in combination with the Hydrafacial, which is able to  reduce redness commonly caused by rosacea. Hydrafacials are also a wonderful option for patients struggling with a combination of rosacea and acne vulgaris, as well as those looking for treatment of discoloration and facial wrinkles.

Oral medications for rosacea treatment

A common rosacea treatment option is that of oral antibiotics, including doxycycline, minocycline, or tetracycline. When it comes to facial rosacea or acne rosacea, Dr. Green will typically prescribe Doxycycline (Oracea). In the case of severe acne rosacea, Dr. Green may recommend Isotretinoin (Accutane) in order to heal the skin from chronic pustules or blemishes due to acne rosacea. Isotretinoin is more commonly used to treat traditional acne, but it can be an effective method to treat acne rosacea in some cases.

How to get started with acne rosacea treatments today

If you’re frustrated by the appearance of facial redness or red bumps, there are solutions that can help. Dr. Green has over 25 years of experience in cosmetic dermatology in NYC, laser treatments, Botox®, dermal fillers, Sculptra® injections, treating sun spots and hyperpigmentation, acne, acne scarring, chemical peels, CoolSculpting® and Thermage®. An expert in non-invasive cosmetic treatments, Dr. Green is consistently voted as one of the best doctors in New York by Castle Connolly, Super Doctors, and New York Magazine. To schedule a consultation please call New York City office today at 212-535-3088 or contact us online to have Dr. Green develop the best customized acne rosacea treatment plan for you.

Related Topics

Call Us (212) 535-3088