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When it comes to our skin, little red bumps can develop for a variety of reasons. Two of the most common skin conditions that involve red blemishes or raised pimples are that of 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 patients consult a dermatologist, like Dr. Michele Green in New York.

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.

SL 21 year old after 5 Vbeam for rosacea MGWatermark

Female treated with 5 treatments of VBeam for Rosacea and Acne

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, sensitive skin, and will help determine the cause and best treatment for your skin. She will help you select the best skin care treatment, possible systemic treatment and cosmetic treatments necessary to improve your acne/rosacea. Whether it be VBeam® laser treatment to remove telangiectasis and facial redness, HydraFacials to clean out clogged pores, or chemical peels to exfoliate the skin, Dr. Green will guide you to refresh and maintain beautiful skin.

Do I have rosacea or acne?

When assessing whether a patient is dealing with acne or acne rosacea, it is important to think about the varied ways in which these skin diseases develop. 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, on the other hand, is caused by a variety of environmental factors, and typically develops initially as redness or itchiness on the surface of the skin. 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: Phymatous 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.

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Symptoms of Rosacea vs. Acne

For patients who are dealing with subtype two of rosacea, acne rosacea  symptoms can look very similar to that of traditional acne lesions. Acne rosacea typically presents with pustules, redness, oily and sensitive skin, raised patches of skin, and, in severe cases, broken blood vessels that are visible.

Acne is typically defined by papules, pustules/pimples, comedones/blackheads, and cysts. While Rosacea can be accompanied by pimples, it does not generally present as comedones, also known as blackheads and whiteheads. Comedones typically are caused by debris and oil that are trapped within a pore. 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 acne rosacea.

Can 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 and discuss your medical history and daily patterns to determine if you’re struggling with traditional acne or acne rosacea.

Rosacea acne causes and risk factors

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.

BR Before and after Botox and 3 VBeam MGwatermark

Botox & Vbeam, 3 treatments, 3 months

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, or dietary triggers such as alcohol, hot beverages, or spicy foods. 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, 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 immense knowledge on 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.

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Rosacea acne on nose

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.

How to treat 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.

Rosacea Acne Skincare Options

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.

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Male treated with VBeam for Rosacea

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.

hydrafacial - Before After - source

Oral Medication Rosacea Treatments

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 (commonly referred to as Accutane) in order to heal the skin from chronic pustules or blemishes due to rosacea. Isotretinoin is more commonly used to treat traditional acne, but it can be an effective method to treat acne rosacea in some cases.

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, 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 contact Dr. Green online or call our New York City office at 212-535-3088 and develop your customized treatment plan.

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