Ask a Dermatologist: What’s the Difference Between Acne and Rosacea?




If you find it tricky to distinguish between acne and rosacea, you’re not alone: Though they’re distinct skin conditions, requiring very different treatment approaches, they can sometimes appear with lookalike symptoms. For instance, papulopustular rosacea, a moderate form of the condition, typically shows up as persistent redness and pimple-like bumps.

We asked Dr. Marcie Ulmer, a Vancouver dermatologist and spokesperson for the Acne and Rosacea Society of Canada, how to differentiate rosacea from acne, and how to treat and prevent flare-ups.

What are the main causes of rosacea, and who is at risk? 

In some patients, there is a family history of rosacea and a genetic component; individuals with fair complexions of northern European descent tend to be more susceptible. Rosacea patients have an impaired skin barrier function and skin inflammation, and research is being done [on how] the vascular and nervous systems [are involved in the condition]. People with rosacea tend to flush easily and may have background redness and dilated blood vessels. They also tend to have a higher number of normal skin mites, which are possibly involved in the inflammation associated with rosacea. It often starts between the ages of 30 and 50, and affects more women than men.

Can rosacea be prevented?

There is no known way to prevent or cure rosacea, but it can be successfully managed.

How can rosacea best be treated?

[People with rosacea symptoms should] see a doctor first. A visit with a dermatologist may be necessary if the diagnosis is in question, or standard therapy is not effective. With the right diagnosis, there are many very effective treatments available. Flare-ups of rosacea can be minimized by avoiding known triggers such as spicy foods, hot beverages and alcohol, rigorous exercise, stress, excessive heat, certain cosmetics and sun exposure. Triggers are different for each person, so it is important to find out what an individual’s aggravating factors are. UV exposure is a common trigger, so it is recommended that people with rosacea use a minimum SPF 30 sunscreen daily.

Why is rosacea so often confused with acne? 

Both acne and rosacea can present with red pimples, pustules and redness. While it is possible to experience both acne and rosacea simultaneously—and some medications do help both—it is important to have an accurate diagnosis to ensure appropriate treatment. [See Dr. Ulmer’s chart below for a rundown of the key differences.]

What is the main risk if rosacea is mistaken for acne?

If a patient with rosacea is mistakenly treated for acne, their skin can become quite inflamed and irritated. Rosacea patients tend to have sensitive skin in general, and adding an acne therapy can be very drying and irritating to their skin.


Is It Acne or Rosacea?

Vancouver dermatologist Dr. Marcie Ulmer breaks it down:




Who’s Affected

Most often teens; 1 in 5 women aged 20-50

Mainly women aged 30-50


Blackheads, whiteheads, pimples (pustules), red bumps (papules) and/or cysts

Pimples (pustules) and red bumps (papules)

There are no blackheads or whiteheads in the area where pimples have broken out


Red circles around inflamed pimples or within red bumps

Areas of permanent redness on the face, most often on the cheeks, nose, forehead or chin

Affected Areas

Face, neck and/or sometimes back or chest

Central face, especially on cheeks, nose, forehead or chin, and sometimes neck or chest

Blood Vessels


Tiny blood vessels visible



Easy flushing and blushing


Not affected

More than half of rosacea sufferers have eye symptoms—watery eyes, irritation, foreign body sensation, red lids or more serious disease


Some deep acne cysts can be very painful

Sometimes a burning sensation and skin sensitivity


Usually during the teen years

For some adults, into their 20s, 30s and even 40s

A lifelong condition that starts in the late 20s or 30s

Family History

Almost everyone experiences some degree of acne at some point

30 percent of rosacea patients have a close family member with the condition


Affects people of all ethnicities

Affects mainly those of Celtic or northern European origin


Tight headwear such as helmets; skin friction causing irritation; stress; and for some, consuming a high-glycemic diet or dairy

Exposure to sunlight; consuming alcohol, hot/spicy foods or hot drinks; stress; strenuous exercise; hot baths or showers; crowded spaces; cold and/or windy weather; and some topical products

Treatment Options

Over the counter: oil-free, gentle skincare; products containing salicylic acid and benzoyl peroxide

Prescription: multiple topical and oral medications are available; laser therapy can be beneficial for acne scars

Over the counter: gentle skincare, camouflage makeup and sunscreen

Prescription: multiple topical and oral medications are available; laser therapy and intense pulsed light (IPL) can be beneficial for dilated blood vessels and redness


Acne can be controlled with self-care and medical treatment if needed

Treatment has been shown to significantly improve the condition and improve a person’s outlook

Although it cannot be cured, rosacea can be controlled with self-care and medical treatment if needed

Treatment has been shown to significantly improve the condition and improve a person’s outlook