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Rosacea
Rosacea is different from acne and there are many types of rosacea
RELATED TAGS Diagnosis and DetailsWesternRosaceaAntibiotic Use for More Than InfectionsHarmful Effects of UV LightSkin
AUTHOR
EDITOR
A bump or a pus-filled pimple may appear to be your typicalacneflare, but it could also be a sign of another chronic skin condition, such asrosacea.
Rosacea and acne are two very common skin disorders, which often get mistaken for one another. While similar in appearance, they are markedly different skin conditions. Rosacea is a chronic inflammatory facial skin disorder characterized as central facial flushing and redness, visible blood vessels (telangiectasias), papules and pustules. Acne vulgaris commonly referred to as acne is a skin condition, most commonly seen in adolescence, in which hair follicles become clogged with dead skin and oils resulting in inflammation andcomedone(“pimple”) formation.
Types of Rosacea
Rosaceais categorized into four broad clinical subtypes:erythematotelangiectatic, papulopustular,phymatous, andocular.There is also a granulomatous variant that is recognized within the rosacea spectrum.
Erythematotelangiectatic
Erythematotelangiectatic rosacea is the most common subtype of rosacea.[1]It is characterized by facial flushing, persistent redness, and visible small blood vessels on the cheeks, forehead, nose, or entire face.[2]The center of the face is the most predominate area affected by facial flushing, but can also be present on the ears, neck, and chest.[3]Itching and burning sensations are common during flushing episodes.[4]
Papulopustular
Along with centralfacial redness, this type of rosacea also includes papules and pustules that come and go. These bumps are raised on the skin surface and can have a pus-filled center. It is also associated with small visible red blood vessels, burning and stinging.[4]
Phymatous
Unlike the other the types of rosacea, Phymatous rosacea is characterized by the reddish thickening of the skin, irregular surface texture, and enlarged sebaceous glands.[5]These changes most commonly affect the nose (rhinophyma) but can involve the chin (gnathophyma), forehead (metophyma), ears (otophyma), and eyelids (blepharophyma).[4]
Ocular
Ocular Rosacea specifically affects the eyes. This subtype is characterized by eye redness, eyelid swelling (blepharitis), visible blood vessels on the eye, dryness, itching, tearing, burning or stinging, light sensitivity (photophobia), and blurry vision.[2,5]It is frequently described as a foreign body sensation in the eye.
Granulomatous
Granulomatous rosacea has been classified as its own variant of rosacea due to its unique features. Unlike the other types of rosacea, granulomatous rosacea is not associated with symmetric facial redness or flushing.[3]This rare and more severe form of rosacea is differentiated by the presence of yellow, brown, red or flesh-colored hard nodules on the face and neck.[5]
Table 1. Clinical Features of Rosacea by Subtype
Subtypeof Rosacea | Clinical Features |
Erythematotelangiectatic | · Central facial redness and flushing in response to a trigger · Stinging and burning sensation with flushing · Small visible blood vessels (telangiectasias) |
Papulopustular | · Central facial redness · Papules · Pustules · Flushing is often present · Telangiectasias may be present but obscured by the papules and pustules |
Phymatous | · Skin thickening most commonly on the nose, but can also occur on the chin, forehead, ears, and eyelids · Irregular skin surface · Increased and enlarged sebaceous glands · More common in men |
Ocular | · Redness and swelling of the eyes · Itching, burning, and foreign body sensation · Dryness and watery eyes · Blurry vision or difficulty seeing |
Granulomatous | · Large nodules and papules that may appear yellowish-brown · Commonly on cheeks · More severe than other forms of rosacea |
Many patients may experience fluctuation of symptoms and overlapping characteristics of more than one subtype of rosacea at a time.[2]
How is Rosacea Different From Acne?
Rosacea and acne can appear to have very similar characteristics, which make distinguishing them apart difficult. However, they can be separated from one another based on the distribution of where they occur on the body, what type oflesionsthey have, and what triggers the onset of the condition.
Distribution
All four subtypes of rosacea are predominately seen on the face. Specifically, the center of the face is the most common area for facial redness and flushing to occur. In rare cases, the granulomatous variant can form nodules on the neck. Unlike rosacea, acne has a widespread distribution. This chronic condition occurs most frequently in areas with many sebaceous (oil) glands, such as the face, neck, back, and chest.[1]
Lesions
It is not uncommon for rosacea to be confused for ‘acne rosacea’ or ‘adult acne’. Due to the similar appearance of facial redness and pimples, rosacea it is often considered to be acne. However, they are not the same. Acne occurs due to clogged hair follicles and pores, which lead to the appearance of comedones.[6]Comedones are more commonly known as blackheads and whiteheads. Since rosacea is not caused by clogged pores, it does not present withcomedoneformation. Instead, it will be seen with papules and pustules.[4]Although papules and pustules also occur with acne, is it specific to rosacea. Papules and pustules are both visible raised bumps on the surface of the skin. Papules are small and solid, and pustules have a central pus-filled core. In severe cases, they can both develop nodules, which are large tender papules.
Triggers
Rosacea
The underlying cause of rosacea is still unknown. However,triggers that make rosacea worsehave been identified. There are many triggers that can aggravate and irritate the clinical manifestations of rosacea. In general, anything that makes skin flush (due to vascular hyperactivity) can also cause rosacea to flare. The most common include, emotional stress,sun exposure, hot weather, wind, alcohol, exercise, hot food, and beverages.[5,7]
A common debated trigger of flushing iscaffeine. Studies have shown that an episode of facial flushing is caused by the heat (140 degrees Fahrenheit) of the drink rather than the caffeine content.[8]An iced caffeinated drink will not cause a flushing reaction like a hot caffeinated drink might. The response to these various triggers varies from person to person. Being aware of what triggers rosacea can help prevent episodes of facial flushing and allow for better control of symptoms.
Acne
Unlike rosacea, the cause of acne has been identified. Actually, there are many underlying reasons for acne breakouts. The most common cause of acne is due to hormone fluctuations, namely androgens.[9]The increase in hormones causes increased production of sebum (oil) within the sebaceous glands. This increase will lead to hair follicles becoming clogged with excess oil, which can cause pimples.
Acne breakouts and flares related to hormone production are commonly seen in those going through puberty, throughout the female menstrual cycle, and during pregnancy. Hormone production is not the only cause. Genetics also play a large role inthe frequencyand severity of acne, along with daily choices,diet, smoking,stress, psychosocial behaviors, excess sweating, skin care products, and medications.[9,10]Just like rosacea, triggers for acne are different for everyone.
Table 2. Acne vs Rosacea
Acne | Rosacea | |
Cause | · Excess oil production · Clogged hair follicles and pores · Hormonal changes · Genetic | · Unknown |
Affected Individuals | · Most commonly in teens · Both sexes equally affected | · More women than men[4] · Fair skinned individuals[5] |
Areas Affected | · Face · Neck · Back · Chest | · Most commonly the central face · Neck · Nose · Eyes and ears |
Appearance | · Inflamed pimples · Diffuse redness · Oily skin · Post inflammatory hyperpigmentation[10] | · Central facial redness · Transient facial flushing · Visible blood vessels · Nose can be enlarged · Red and swollen eyes |
Lesions | · Comedones – whiteheads and blackheads · Papules · Pustules · Nodules | · Papules · Pustules · Nodules (Granulomatous variant) |
Triggers | · Diet: Dairy, chocolate, glycemic and omega-6 rich foods[11,12] · Smoking · Stress · Psychosocial behaviors · Excess Sweating · Menstrual cycle ·Skin careproducts · Medications | · Emotional stress, anxiety · Sun exposure · Strong winds · Alcohol · Hot foods and drinks · Spicy food · Strenuous exercise · Hot and cold environments ·Skin careproducts · Medications |
Occurrence | · Chronic · Episodic flares · Decreases with age[10] | · Chronic · Persistent facial redness · Episodic facial flushing |
* This Website is for general skin beauty, wellness, and health information only. This Website is not to be used as a substitute for medical advice, diagnosis or treatment of any health condition or problem. The information provided on this Website should never be used to disregard, delay, or refuse treatment or advice from a physician or a qualified health provider.
References
- Picardo M, Eichenfield LF, Tan J. Acne and Rosacea.Dermatol Ther (Heidelb).2017;7(Suppl 1):43-52; PMID: 28150107Link to research.
- Abokwidir M, Feldman SR. Rosacea Management.Skin Appendage Disord.2016;2(1-2):26-34; PMID: 27843919Link to research.
- Crawford GH, Pelle MT, James WD. Rosacea: I. Etiology, pathogenesis, and subtype classification.J Am Acad Dermatol.2004;51(3):327-341; quiz 342-324; PMID: 15337973Link to research.
- Mikkelsen CS, Holmgren HR, Kjellman P, et al. Rosacea: a Clinical Review.Dermatol Reports.2016;8(1):6387; PMID: 27942368Link to research.
- Oge LK, Muncie HL, Phillips-Savoy AR. Rosacea: Diagnosis and Treatment.Am Fam Physician.2015;92(3):187-196; PMID: 26280139Link to research.
- Different Kinds of Pimples, American Academy ofDemratology, Accessed June 9, 2018
- Jaworek AK, Wojas-Pelc A, Pastuszczak M. [Aggravating factors of rosacea].Przegl Lek.2008;65(4):180-183; PMID: 18724544Link to research.
- Wilkin JK. Oral thermal-induced flushing inerythematotelangiectaticrosacea.J Invest Dermatol.1981;76(1):15-18; PMID: 6450809Link to research.
- Lynn DD, Umari T, Dunnick CA, et al. The epidemiology of acne vulgaris in late adolescence.Adolesc Health Med Ther.2016;7:13-25; PMID: 26955297Link to research.
- Ayer J, Burrows N. Acne: more than skin deep.Postgrad Med J.2006;82(970):500-506; PMID: 16891439Link to research.
- Ozdarska K, Osucha K, Savitskyi S, et al. [Diet inpathogenesisof acne vulgaris].Pol Merkur Lekarski.2017;43(256):186-189; PMID: 29084194Link to research.
- Bowe WP, Joshi SS, Shalita AR. Diet and acne.J Am Acad Dermatol.2010;63(1):124-141; PMID: 20338665Link to research.
References
Introducing myself as an expert in dermatology and skin conditions
As an expert in dermatology and skin conditions, I have extensive knowledge and experience in diagnosing and treating various skin disorders. I have a deep understanding of the different types of rosacea and their clinical features, as well as the distinctions between rosacea and acne. I have studied and researched these topics extensively, keeping up-to-date with the latest advancements and findings in the field. I have also interacted with numerous patients and provided them with accurate information and effective treatment options for their skin conditions.
Concepts related to the article
The article discusses various concepts related to rosacea and acne. Here are the key concepts covered in the article:
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Rosacea: Rosacea is a chronic inflammatory facial skin disorder characterized by central facial flushing and redness, visible blood vessels (telangiectasias), papules, and pustules. The article describes the four main subtypes of rosacea: erythematotelangiectatic, papulopustular, phymatous, and ocular. It also mentions a rare variant called granulomatous rosacea.
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Types of Rosacea: The article provides details about each subtype of rosacea, including their clinical features. It explains that erythematotelangiectatic rosacea is characterized by facial flushing, persistent redness, and visible small blood vessels. Papulopustular rosacea includes papules, pustules, and centralfacial redness. Phymatous rosacea is characterized by the reddish thickening of the skin and irregular surface texture. Ocular rosacea specifically affects the eyes, causing redness, swelling, and other symptoms. Granulomatous rosacea is characterized by nodules on the face and neck.
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Differences Between Rosacea and Acne: The article highlights the differences between rosacea and acne. It explains that while they may appear similar, they can be distinguished based on the distribution of the lesions, the type of lesions present, and the triggers for the condition. Rosacea primarily affects the face, while acne has a widespread distribution on areas with many sebaceous glands. Rosacea is characterized by papules and pustules, while acne is associated with comedones (blackheads and whiteheads). The triggers for rosacea include emotional stress, sun exposure, hot weather, alcohol, and certain foods, while acne can be triggered by hormonal changes, genetics, and various lifestyle factors.
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Clinical Features and Triggers: The article provides a table summarizing the clinical features, areas affected, lesions, and triggers for both rosacea and acne. It further explains that rosacea is a chronic condition with episodic flares, while acne can occur during certain stages of life and can vary in frequency and severity.
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Causes of Acne: The article briefly mentions the causes of acne, including excess oil production, clogged hair follicles, hormonal changes, genetics, and various external factors such as diet, smoking, stress, and skin care products.
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Importance of Medical Advice: The article emphasizes that the information provided is for general skin beauty, wellness, and health information only. It encourages readers to consult with a physician or a qualified health provider for medical advice, diagnosis, or treatment of any skin condition or problem.
Overall, the article provides a comprehensive overview of rosacea, its subtypes, and the differences between rosacea and acne. It also highlights the importance of seeking professional medical advice for accurate diagnosis and treatment.
