6 ways to tell the difference between acne and rosacea. They can look similar!

I am a 64 year old post menopausal woman. I have been taking the same type and dosage of HRT (which has an estrogen and testosterone component) for 12 years. I decreased my dosage to see if that might impact the breakouts but thus far have not seen an appreciable improvement. I had severe acne and was treated with ACCUTANE 30 years ago. For the last year or so my face has been breaking out with small, red little bumps on my nose that eventually come to a head and cystic nodules on my checks or chin that sometimes come to a head. I started using Aczone 7.5% 4 weeks ago and washing with salicylic acid scrub but see little improvement. If I were to try spirolactone would I need to completely stop the testosterone before? My blood pressure is on the lower side around 100-110/60-70.

Thank you for your question! You reminded me that I’ve been seeing many questions about acne and Rosacea. 🙂

Here are 6 ways to tell the difference between acne and Rosacea:

  1. Acne onset is most common in the 11-40 year old age range. Rosacea onset is most common in the 30-70 year old age range.  Since you were in your 60s when this started, you most likely have new onset rosacea, so please see a dermatologist for help.
  2. Acne usually has different appearances in the same person. For example, blackheads, whiteheads, red bumps (papules), pustules and bigger, tender nodules may all exist at the same time. Rosacea usually looks more uniform with red bumps and sometimes pustules.
  3. Food/drink triggers like alcohol, too much coffee, hot liquids, etc., are common with rosacea. Acne usually does not have dietary triggers.
  4. Rosacea is usually associated with flushing or a history of easy flushing and flushing, with a sensation of heat in the face being common. With acne, this is usually not the case.
  5. Acne occurs in all ethnicities. Rosacea often has a strong link to celtic genes. It’s very prevalent in Ireland, Scotland and England.
  6. Rosacea rarely causes any permanent scars on the face. Permanent scars do occur with acne.

Treatment of both acne and Rosacea is key! And often be effective with just prescription creams or gels. With rosacea, dietary changes are often needed. For more of my posts about acne, see the whole section here. For more information on Rosacea and how to treat it, see my articles here.

Please see a dermatologist, if you have either of these or are seeing any signs of permanent scars or indentations.

Hope this helps,  Dr. I


Dr. Brandith Irwin, MD

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Hi, I’m Dr. Irwin. I believe that consumers deserve a medically trained and unbiased skin care advocate.

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