Acne vs. rosacea: what’s the difference?

Table of Contents

Do you experience frequent flushing when trying to enjoy a spicy meal? Do your nose and cheeks get red when you get your sweat on? Does your face sting or burn with certain skincare products? If you answered yes to any of these questions, you may have some mild rosacea—and you’re not alone! 

Rosacea affects an estimated 16 million people in the United States,¹ although many don’t know they have it. Certain symptoms of rosacea can be misdiagnosed as other conditions, especially acne. This can be extra frustrating for patients as the treatments for one condition may not help with the other. 

Here at Curology, we want to empower you to take control of your skincare. That’s why we not only provide information on common skin conditions, we can treat acne and rosacea too. It’s one of our favorite ways to help! With that in mind, let’s learn about two of the most common skin conditions in the United States: acne and rosacea.  

What is acne? 

Acne is a chronic inflammatory skin condition that occurs when pores become clogged with excess sebum (aka oil) and dead skin cells. Bacteria (specifically C. acnes) feed on the sebum, leading to an inflammatory response.² 

There are different types of acne lesions including closed comedones (whiteheads), open comedones (blackheads), papules, pustules, and nodules.³ Acne can be frustrating but is totally treatable! We’ll get more into that later—hang tight! 

And what is rosacea? 

Just like acne, rosacea is also a chronic inflammatory skin condition. It’s characterized by a variety of different symptoms including frequent redness and flushing of the central face. The symptoms typically occur in cycles (aka flare-ups).⁴ They might appear for days or weeks at a time, then disappear, then reappear, and so on. 

What are the key differences between acne and rosacea? 

What does it look like:  

• Acne: Acne appears as different types of lesions including whiteheads, blackheads, papules, and cysts. Redness may occur at the lesion. Blemishes may leave behind a dark or red mark on the skin or an acne scar. 

• Rosacea: Rosacea can appear as a variety of combinations of different signs and symptoms. These include persistent redness in the center of your face, acne-like lesions, visible blood vessels, and sensitive skin.⁵

Where does it show up:  

• Acne: It tends to show up on the face, neck, back, chest, and shoulders.

• Rosacea: It tends to show up on the central face (aka the cheeks and nose). This may extend to other parts of the face including the forehead and chin.⁶

Who gets it: 

• Acne: Everyone can get acne, but it most often occurs in adolescents and young adults.⁷ 

• Rosacea: It occurs more often in women and in people with fair skin. Although it can occur at any age, it’s often diagnosed in people over 30.⁸

Is it possible to have acne and rosacea at the same time? 

It is possible to have both acne and rosacea at the same time—frustrating, we know! That said? Remember that these are separate conditions. Rosacea can present with acne-like bumps, so it’s often mistaken for acne. In fact, it may be incorrectly referred to as “acne rosacea” when this happens!⁹ 

Want to know a trick that can help distinguish between the two conditions? Acne often involves open and closed comedones (aka blackheads and whiteheads), but these do not occur in rosacea. If you see acne-like lesions with rosacea, they’ll be inflammatory papules and pustules and will likely be accompanied by persistent redness or flushing.¹⁰

If you’re not confused enough already, the treatments for both of these conditions can overlap!

How can these conditions be treated?

There is no cure for acne or rosacea, but both of the conditions can be managed with proper treatment and the help of a dermatology provider. 

Lifestyle changes 

Making a few lifestyle changes can make a big difference in both acne and rosacea. When it comes to acne, it may help to make some adjustments to your diet (like minimizing dairy and sugar).¹¹ It can also help to change up your workout clothes and gear.

As for rosacea, making lifestyle changes can have a huge impact on how well the condition is managed. Rosacea often flares up with exposure to certain triggers such as spicy food, sun exposure, exercise, and wind.¹² Identifying and avoiding your triggers can make a big difference. In fact, according to the National Rosacea Society, more than 90 percent of patients who identified and avoided their personal triggers saw an improvement!¹³

Skincare routine 

Acne and rosacea can both be helped by consistently sticking with a simple skincare routine. Here at Curology, we constantly tout the benefits of a 3-step skincare routine for acne patients: cleanse, moisturize, SPF in the morning; cleanse, treat, moisturize at night. 

Cleansing, moisturizing, treating, and sun protection are equally important for rosacea. Cleansers and moisturizers should be gentle and free of potentially irritating ingredients like added fragrance and alcohol.¹⁴ Sun protection is important for everyone but it is especially important for people with rosacea. The sun can trigger rosacea flare-ups in some people, so sun avoidance and proper use of sunscreen can help to control symptoms.¹⁵

Want more rosacea skincare tips? Read our rosacea skincare routine guide, which includes a list of dermatologist-approved product recommendations.

Medication

Topical and oral medications are often an integral part of managing both acne and rosacea. When it comes to acne, prescription topicals like tretinoin and clindamycin can treat breakouts and help new ones from forming. Oral medications like isotretinoin are also used.¹⁶ 

Certain medications, like topical azelaic acid and oral doxycycline, can be used to treat both conditions. Keep in mind, though, that the strengths used to treat each condition often differ. 

Other medications used to treat rosacea include metronidazole, ivermectin, and sodium sulfacetamide.¹⁷

Treat acne and rosacea with Curology

If you’re struggling with acne, rosacea, or both Curology can help! You can try prescription-strength ingredients like tretinoin, clindamycin, and metronidazole by signing up for a 30-day free trial of Curology. Just snap a few selfies and take a quick skin quiz, and then we’ll match you with a medical provider trained and licensed to practice dermatology in your state.

Get your personalized skincare routine with Curology

Subject to consultation. 30-day trial. Just cover $4.95 in S&H.

If Curology is right for you, we’ll send you a Custom Formula with a mix of ingredients chosen for your unique skin concerns, plus any of our recommended products, for $4.95 (plus tax) to cover shipping and handling. 

P. S. We did our homework so you don’t have to.

1.  American Academy of Dermatology Association. Skin conditions by the numbers. American Academy of Dermatology. (n.d.).

2. Toyoda, M., & Morohashi, M. Pathogenesis of acne. Medical electron microscopy: official journal of the Clinical Electron Microscopy Society of Japan. (2001).

3.  Zaenglein, A. L., et al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. (2016). 

4.  Gallo, R. L., et al. Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee. Journal of the American Academy of Dermatology. (2018).

5.  Jerry Tan and Diane Thiboutot. All about rosacea. National Rosacea Society. (2022).

6.  American Academy of Dermatology Association. Rosacea: Overview. American Academy of Dermatology. (n.d.). 

7.  Zaenglein, A. L., et al. Guidelines of care for the management of acne vulgaris. Ibid. 

8.  Gallo, R. L., et al. Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee. Ibid.

9.  National Rosacea Society. Acne or Rosacea? A Case of Mistaken Identity. 

10.  National Rosacea Society. Acne or Rosacea? A Case of Mistaken Identity. 

11.  Zaenglein, A. L., et al. Guidelines of care for the management of acne vulgaris. Ibid.

12.  Thiboutot, D., et al. Standard management options for rosacea: The 2019 update by the National Rosacea Society Expert Committee. Journal of the American Academy of Dermatology. (2020). 

13.  National Rosacea Society. Rosacea Diary Booklet.

14.  Thiboutot, D., et al. Standard management options for rosacea: The 2019 update by the National Rosacea Society Expert Committee. Ibid. 

15.  Oge', L. K., et al. Rosacea: Diagnosis and Treatment. American family physician. (2015).

16.  Zaenglein, A. L., et al. Guidelines of care for the management of acne vulgaris. Ibid.

17.   Thiboutot, D., et al. Standard management options for rosacea: The 2019 update by the National Rosacea Society Expert Committee. Ibid. 

*Ingredients subject to provider consultation. Cancel anytime.

Written by

Curology Team

Medically reviewed by

Nicole Hangsterfer, PA-C