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Red apple to represent acne and rosacea

Do I have acne or rosacea? Symptoms and how to tell

Medically reviewed by
Dr. Dina Sabih from Derma Medical Center

If you have rosacea, you’re not alone – it affects millions around the world, with as many as one in 10 people experiencing it.

Despite being so common, rosacea and acne are often confused – even though the two conditions are actually very different. So how do you know which you have?

What are the main differences between acne and rosacea?

  • Rosacea generally only affects the face. Acne, on the other hand, can affect the face, back, neck and chest.
  • Acne often affects people aged between 11 and 30, but people in their 40s, 50s and 60s are most likely to get rosacea.
  • Though both conditions can result in spots, it is less likely with rosacea – and the types of spots are more varied with acne.

Symptoms of rosacea NOT commonly associated with acne

  • Red skin at the centre of your face.
  • Stinging and sensitive skin on your face.
  • Visible blood vessels on your cheeks, nose and forehead.
  • Swollen skin around the eyes.
  • Enlarged, bulbous nose – more common in men.

Symptoms of acne NOT commonly associated with rosacea

  • Spots on your back, chest or neck.
  • Oily skin.
  • Redness limited to spotty areas of the skin.
  • Spots such as blackheads, whiteheads and nodules – as well as cysts.

How can I tell if I have rosacea?

Rosacea is a long-term skin condition that mainly affects the face. It is common in women and people with lighter skin, but symptoms can be worse in men. The symptoms range from persistent redness, bumps and pimples, and visible blood vessels, to occasional eye irritation. Your skin may also experience burning or stinging, swelling and dryness.


Unfortunately, the exact causes of rosacea are still a mystery. There has been links with auto-immune disorders, systemic inflammation, and even the over-population of the common skin mite Demodex folliculorum. It’s also believed to be genetic and can be bought on initially by hormonal shifts such as pregnancy or the perimenopause.

Consult a professional

There is no specific test for the condition, but your doctor or dermatologist should be able to diagnose it by sight.

Your dermatologist will also be able to tell you whether it is acne you’re experiencing instead – or another skin condition altogether.

Are the treatments I can try different for acne and rosacea?

There is some crossover between the treatments for acne and rosacea, however, those with rosacea tend to have more sensitive skin, so while a chemical peel might be an effective treatment for acne, IPL or light treatment would be a kinder option for rosacea.


If you have acne-prone skin, it can be tempting to use strong products to ‘combat’ spots. However, taking a gentle approach is actually better. Try going back to basics with a skincare reset – using just a cleanser, moisturiser and SPF for six weeks – then build your new routine around a core of products, adding them one at a time.

Take your pick from the following depending on your personal needs: vitamin C for brightness; acids for texture; retinol for ageing.

Rosacea-prone skin can be super-sensitive and when it comes to skincare, sometimes less is more. If you’re using a lot of products and experiencing stinging or more redness after use, speak to an esthetician or dermatologist.

They can advise you on the right products to build up your skin barrier and reduce flare-ups and breakouts.


For both acne and rosacea, a healthy diet is about moderation, flexibility and balance rather than cutting out everything you like. Play around with eliminating foods one at a time and keep a diary to track results. And while coffee is often blamed for a multitude of skin conditions, some studies believe it’s the heat, not the caffeine to blame for flushing. Switch to an iced cappuccino and enjoy.

The only non-negotiable is the sun. Always – always – wear a good quality SPF, and double up with a hat or sit in the shade if it’s a particularly sunny day.


Oral and topical antibiotics prescribed by a doctor are used to treat both acne and rosacea. The most popular oral type is tetracycline, which is initially prescribed for 12 weeks. Accutane can also be prescribed for those with severe cystic acne. Topically, erythromycin and clindamycin are both potentially effective in the treatment of inflammatory acne, while for rosacea, metronidazole is often used in combination with an oral treatment. Ivermectin which is an anti-parasitic is also popular for those with rosacea with a high success rate.

Azelaic acid

A naturally occurring substance that comes from grains like barley and wheat, azelaic acid has antimicrobial and anti-inflammatory properties, and can be used to treat both acne and rosacea, clearing pores of bacteria and reducing inflammation. It can be bought over the counter but is typically prescribed by a doctor or dermatologist.

Energy Based Devices

IPL (Intense pulsed light) therapy is a treatment that applies strong light to your skin, and it can be used to treat both acne and rosacea.

85 per cent of patients in a recent study reported improvements to their acne symptoms, while use with rosacea has seen similar success.

A versatile treatment, it’s also used for hair removal.

Further thoughts…

Speak to your doctor about having your thyroid checked. Recent studies suggest a connection between those with rosacea and auto-immune disorders.


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