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Rosacea is a skin condition characterized by facial redness, visible blood vessels, and inflamed red bumps that are similar in appearance to pimples. Often, rosacea flare-ups may be mistaken for another common skin condition- acne vulgaris. Although there are several subtypes of rosacea, many rosacea patients have to deal with acne-like breakouts whenever they experience a flare-up. Using topical skincare products that are designed to treat acne vulgaris, however, can cause the symptoms of rosacea to worsen. Consulting with a board-certified dermatologist, like Dr. Michele Green in NYC, is the best way to develop an acne rosacea treatment plan.

One of the most difficult aspects for a patient with inflammation, facial redness, or sensitive skin is understanding how to properly treat the pimples and papules on the surface of the skin. Rosacea flare-ups can manifest themselves 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, smooth skin that lasts.

If you’re suffering from acne-like breakouts, facial redness, visible blood vessels, or other symptoms of rosacea, board-certified dermatologist Dr. Michele Green is here to help. Dr. Green is an internationally renowned expert in the field of dermatology, with over two and a half decades of experience treating some of the most discerning patients from around the world. She will help select the right skin care regimen, oral and topical treatment, and any cosmetic treatments necessary to improve the condition of your acne rosacea. Whether it be VBeam® laser treatment to diminish the appearance of blood vessels, telangiectasis, and facial redness, HydraFacials, or chemical peels, Dr. Green will help you achieve and maintain beautiful, healthy skin.

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Accutane for Acne, 1 and 5 months before and after

What does rosacea look like?

Rosacea is a skin condition that is characterized by facial redness/flushing, often accompanied by broken blood vessels and small red bumps that may 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 the 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 around the eye.

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, 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, 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.

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Female treated with VBeam and Thermage

What are common rosacea 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.

Is rosacea a form of acne?

Rosacea is similar to acne vulgaris, but it is not the same skin disease. Rosacea can, however, cause acne-like breakouts of inflamed, pus-filled lesions. Although there are some similarities between the symptoms of rosacea and acne, there are also some key differences between the two skin conditions. For instance, the red bumps associated with a rosacea flare do not develop as a result of pores becoming clogged with excess sebum and dead skin cells. Breakouts of acne vulgaris typically include whiteheads, blackheads, cysts, nodules, pustules, and papules that form due to excess sebum clogging the pores. Additionally, rosacea tends to cause diffuse facial redness whereas redness associated with acne vulgaris usually just surrounds the pimples.

What is the difference between acne vulgaris and acne rosacea?

Acne vulgaris 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 telangiectasia, and broken blood vessels. The symptoms and presentation of both acne and rosacea are similar, and so are the treatments involved for each.

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 review your medical history and daily patterns to determine the best treatment options for your acne rosacea.

What causes 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.

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 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.

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 acne rosacea breakouts, 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.

Where does rosacea appear?

Rosacea acne is most commonly found on the center of the face, including the bridge of the nose and the cheeks, the forehead, and the chin. The neck and chest may also be affected by symptoms of rosacea, though this is less common. If acne rosacea remains untreated, over time, symptoms such as facial redness and red bumps may worsen, and in severe cases may cause the nose to become misshapen (rhinophyma). Ocular rosacea is a specific subtype of rosacea that affects the eyes and eyelids, causing dryness and irritation.


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 facial redness, thickened facial skin, and red bumps. This form of acne 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.

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Female treated for acne – 8 months before and after

How can I get rid of rosacea?

While there is no cure for rosacea, there are a number of treatment options available to help manage symptoms as well as methods for preventing flare-ups. The best way to get started with developing a treatment plan for your rosacea is to consult with a board-certified dermatologist, such as Dr. Michele Green in NYC. Dr. Green is an expert in the field of dermatology with over 25 years of experience creating customized treatment plans for some of the most discerning men and women from around the world. She is consistently voted as one of the best physicians in New York City by Castle Connolly, New York Magazine, the New York Times, and Super Doctors for her dedication to her patients and expertise, and will work with you to develop an acne rosacea treatment plan that is best suited to your skin condition.

How to treat rosacea

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 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 a skin condition associated with an inflammatory response on the surface of the skin, it tends to present with larger areas of facial redness and raised patches surrounding a protruding pimple. However, in some cases, patients may be dealing with both acne rosacea and acne vulgaris, which must be treated very carefully so as to prevent worsening skin irritation or further infection.

If you think you may have a case of severe acne rosacea or breakout of cystic acne vulgaris, it is important to seek treatment from a healthcare professional with the expertise and experience required to appropriately treat your skin condition. Dr. Green has 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 to achieve a healthy, smooth, clear complexion that lasts.

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VBeam – 2 months before and after

How to clear up rosacea breakouts

A wide range of treatment options available for rosacea breakouts is available at Dr. Green’s private, boutique dermatology office in the Upper East Side neighborhood of Manhattan. The first step in getting the best acne rosacea treatment plan will be to book a consultation appointment with Dr. Green. During your consultation, she will assess your skin condition and make a recommendation about the treatment plan that will best meet your unique skin care needs. Acne rosacea 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 breakouts. Dr. Green may also prescribe an 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 acne rosacea treatment plan for you, Dr. Green will take into account your current condition and personal aesthetic goals.

How to get rid of rosacea acne bumps/ pustules

To prevent your skin condition from worsening, it is important to consult with a board-certified dermatologist, such as Dr. Michele Green in New York City, if you are suffering from a flare-up of acne rosacea. Mild to moderate breakouts of rosacea pustules can often be successfully treated with a topical treatment. More severe symptoms are often treated with a combination of topical and oral medications. Using the wrong rosacea treatments can lead to increased skin irritation and aggravate the rosacea.

What is the best treatment for rosacea acne?

There are many different treatment options for addressing the various symptoms of rosacea. The best treatment for your acne rosacea will vary depending on which symptoms you suffer from. Often, topical treatments are the first to be recommended for mild symptoms of rosacea. Oral medications are typically reserved for the treatment of moderate to severe symptoms of rosacea. When you consult with Dr. Michele Green at her private dermatology office in the Upper East Side neighborhood of Manhattan, she will work with you to create a customized acne rosacea treatment plan that is best suited to your unique needs and skin condition.

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 components of rosacea
  • Metrogel®, or Metronidazole, is 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), is 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.

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 breakouts of chronic pustules or blemishes due to acne rosacea. Isotretinoin is more commonly used to treat acne vulgaris, but it can be an effective method to treat acne rosacea in some cases.

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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 soothe 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 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, from 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 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 Hydrafacial, which is able to reduce the 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 the treatment of discoloration and facial wrinkles.

Why is my rosacea getting worse?

The various symptoms of rosacea may be exacerbated by a number of triggers. When rosacea flares up and is left untreated, the skin condition can worsen over time. The triggers that cause a flare-up of rosacea may differ from person to person, however, some of the most 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 makeup or hair care products, may cause irritation and a flare-up of rosacea. Additionally, using skincare products that are traditionally used to treat acne breakouts to treat symptoms of rosacea can cause skin irritation to worsen. The ingredients in many acne-fighting skincare products, including salicylic acid and retinol, are too harsh for individuals with rosacea, ultimately aggravating their skin condition. To understand how to best treat your rosacea, it is important to get a diagnosis and develop an acne rosacea treatment plan with a board-certified dermatologist, such as Dr. Michele Green in NYC.

Does acne rosacea ever go away?

Unfortunately, when left untreated, rosacea is a skin condition that 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. There is no cure for rosacea, but treatment can help control symptoms and prevent flare-ups. Luckily there are many ways to treat rosacea acne and a wide variety of options are available at Dr. Green’s private NYC dermatology office including in-office procedures, such as laser treatment, intense pulsed light therapy, and photodynamic therapy, oral medications such as doxycycline, minocycline, or tetracycline, and topical medications. Dr. Green will work with you to develop an acne rosacea treatment plan that is tailored to your needs.

Does retinol help acne rosacea?

Retinol, derived from vitamin A, is a common skincare ingredient that accelerates the rate of skin cell turnover and stimulates new collagen production. Many anti-aging skincare products contain retinol, as it improves the overall appearance of the skin tone and texture. Although retinol is often used to treat acne vulgaris, it can actually worsen an active flare-up of acne rosacea. 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 whether incorporating retinol into your skincare routine is the right choice for you.

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Male treated with VBeam for Rosacea

How to get started with acne rosacea treatment today

Although rosacea is a common skin condition, the presence of facial redness, pimples, and other frustrating skin problems associated with rosacea can negatively impact one’s overall quality of life and self-esteem. Luckily, Dr. Green offers a host of treatment options in her private dermatology office that can effectively manage the various symptoms of rosacea. Dr. Michele Green is an internationally renowned board-certified dermatologist with over 25 years of experience providing her patients from around the world with the best non-invasive treatment options available including laser treatments, Botox®, dermal fillers, chemical peels, CoolSculpting®, and Thermage®, among others.

For her dedication to her patients and expertise, Dr. Green is consistently voted as one of the best physicians in New York by Castle Connolly, Super Doctors, and New York Magazine. When you consult with Dr. Green at her private dermatology office in the Upper East Side neighborhood of Manhattan, she will work with you to develop a customized acne rosacea treatment plan that is best suited to addressing your specific skin concerns. To get started with treating your rosacea, schedule a consultation with Dr. Green by calling the NYC-based office at 212-535-3088 or contacting us online.

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