Acne vs. rosacea: What’s the difference?

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

Rosacea is a common chronic skin condition that affects an estimated 16 million people in the United States,¹ although many don’t even know they have it. Specific rosacea symptoms are often misdiagnosed as other conditions, especially acne vulgaris. This can be extra frustrating for patients, as the treatments for one condition may not help with the other and at times, they can overlap.

Here at Curology, we want to empower you to take control of your skincare. Education is the first step, but we treat common skin conditions 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: 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 it’s totally treatable. We’ll get more into that later! 

What is rosacea? 

Like acne, rosacea is a chronic inflammatory skin condition. It’s characterized by various symptoms, including frequent redness and flushing of the central face. The symptoms typically occur in cycles⁴ (aka flare-ups). They might appear for days or weeks at a time, then disappear, reappear, and so on. Inflammatory rosacea, or papulopustular rosacea, is sometimes mistaken for acne.

What’s the difference between acne and rosacea? 

Acne and rosacea look similar. But while both may cause symptoms like facial redness, bumps, and pimples, there are critical differences in appearance, location, and typical demographics. You can have acne and rosacea at the same time. 

What does it look like? 

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

• Rosacea: Rosacea can appear as various combinations of different signs and symptoms. These include persistent redness in the center of the face, acne-like lesions, visible blood vessels, and frequent blushing.⁵

Where does it show up? 

• Acne: Acne tends to appear on the face, neck, back, chest, and shoulders.

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

3 potential contributing factors to rosacea

Do you ever wonder why some people get red, irritated skin and others never seem to experience it? The answer might lie in these potential contributing factors. Whether it’s genetics, lifestyle choices, or the environment, something’s causing the flushing and red bumps you’re experiencing. Let’s take a closer look at what might be behind rosacea flare-ups.

Diet 

A few different things in your diet may contribute to rosacea.⁹ Experts recommend avoiding spicy drinks or foods and foods that contain capsaicin. Avoiding (or cutting back on) alcohol and reducing your consumption of cinnamaldehyde-related foods (think citrus, tomatoes, and cinnamon) may be beneficial.

Genetics

There may be a genetic component to rosacea, as many people with this skin condition have family members who also have rosacea. Consider your family history if you’re unsure whether your redness is rosacea.¹⁰

Immune system 

The immune system may be involved in developing rosacea. Researchers discovered that many individuals with rosacea have a heightened reaction to the bacterium known as bacillus oleronius, leading to an overactive immune response. But the precise connection between the immune system and rosacea remains unclear.¹¹

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! But remember that these are separate conditions. Rosacea can present with acne-like bumps, so it’s often mistaken for acne. It’s sometimes even (incorrectly) called “acne rosacea!”¹²

How can you tell the difference? 

Acne often involves open and closed comedones (aka blackheads and whiteheads), but these don’t occur with rosacea. If you see acne-like lesions with rosacea, they’ll be inflammatory papules and pustules likely accompanied by persistent redness or flushing.¹³

If you’re not confused enough already, there’s more—even the treatments for these conditions can overlap! 

How can these conditions be treated?

There’s no cure for acne or rosacea, but it’s possible to manage both conditions with proper treatment and the help of a dermatology provider. 

Lifestyle changes 

A few lifestyle changes can make a big difference in acne and rosacea. For acne, adjusting your diet (like minimizing dairy and sugar) may help,¹⁴ as can changing up your workout clothes and gear.

As for rosacea, lifestyle changes can hugely impact how well the condition is managed. Rosacea often flares up with exposure to certain triggers such as spicy food, sun exposure, exercise, and wind.¹⁵ Identifying and avoiding your triggers can make a big difference. In fact, according to the National Rosacea Society, more than 90% of patients who identified and avoided their personal triggers saw an improvement!¹⁶

Skincare routine 

Consistently sticking with a simple skincare routine can help both acne and rosacea. Here at Curology, we constantly tout the benefits of a three-step skincare routine for acne patients: cleanse, moisturize, and apply broad-spectrum sunscreen with SPF 30 or higher in the morning; cleanse, treat, and moisturize at night. 

Cleansing, moisturizing, treating, and using sun protection are equally important for rosacea. Cleansers and moisturizers should be gentle and free of potentially irritating ingredients. UV protection is important for everyone, but it's especially important for people with rosacea. The sun can trigger rosacea flare-ups in some people, so sun avoidance and proper sunscreen use can help to control symptoms.¹⁷

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 integral to managing acne and rosacea. Prescription topicals like tretinoin and clindamycin can treat acne breakouts and help prevent new ones from forming. Oral medications like isotretinoin are also commonly used.¹⁸

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

Other medications used to treat rosacea include metronidazole, ivermectin, and sodium sulfacetamide.¹⁹

Should you pop rosacea pimples?

No! There’s a lot hidden beneath the surface of a pimple, and if what’s inside leaks out, the gunk can contaminate the area around it. When you pop a pimple, the pus inside can spread to the skin under the surface, potentially causing more breakouts and irritation. Plus, you risk driving that bacteria-ridden gunk even deeper into your skin, causing more swelling and inflammation, not to mention dark spots or permanent scarring. So whether it’s acne or rosacea causing your pimples, resist the urge to pop them!

Curology can treat acne and rosacea 

If you’re struggling with acne, rosacea, or both, Curology can help! Curology offers skincare products made with proven effective ingredients. You can try prescription-strength ingredients like tretinoin, clindamycin, and metronidazole by signing up and discussing your needs with one of our experts. 

Our in-house licensed dermatology providers help take the guesswork out of your skincare routine by determining the products your skin needs and creating a custom formula to help meet your skincare goals. To get started, just snap a few selfies and take a quick skin quiz. If Curology is right for you, we’ll send you a personalized prescription formula with a mix of ingredients chosen for your unique skin concerns, plus any of our recommended products.

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

1.  American Academy of Dermatology Association. Skin conditions by the numbers. (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.  Tan, J., Thiboutot, D. All about rosacea. National Rosacea Society. (2022).

6.  American Academy of Dermatology Association. Rosacea: Overview.

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

8.  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. Ibid.

9.  Weiss, E., & Katta, R. Diet and rosacea: The role of dietary change in the management of rosacea. Dermatology Practical & Conceptual. (2017). 

10.  American Academy of Dermatology. Rosacea: who gets and causes. (n.d.).

11.  American Academy of Dermatology. Rosacea: who gets and causes. Ibid.

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

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

14.  Zaenglein, A. L., et al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. Ibid.

15.  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). 

16.  National Rosacea Society. Rosacea Diary Booklet.

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

18.  Zaenglein, A. L., et al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. Ibid.

19.  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).

This article was originally published on April 2022, and updated on March 2023.

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Donna McIntyre is a board-certified nurse practitioner at Curology. She obtained her Master of Science in Nursing at MGH Institute of Health Professions in Boston, MA.

Written by

Curology Team

Medically reviewed by

Donna McIntyre, NP-BC