Rosacea or Something Else?

A red bump or pus-filled pimple may seem like run-of-the-mill acne, but sometimes it’s a sign of another skin condition. So if you have acne along with redness, you might be wondering if you have rosacea.

What Does Rosacea Look Like?

Rosacea, sometimes called acne rosacea, is a chronic inflammatory disease of the skin. Those affected tend to blush, or flush, more easily than others.

Rosacea can be mild or severe. Over time, the redness can spread from the cheeks and nose to the chin and forehead. (1) Rosacea can also cause thickening or enlargement of the skin around the nose.

Rosacea is most common in people with fair skin, particularly those of Celtic or Scandinavian descent. (2) It also occurs in other skin types, but it’s less noticeable in people with darker skin. In fact, rosacea can be underdiagnosed or flat-out missed in every other ethnicity, says Erum Ilyas, MD, a board-certified dermatologist based in the Philadelphia area.

“I routinely have patients of color who have seen numerous other doctors, but have had their diagnosis missed simply because their skin type didn’t show the classic ‘rosy cheeks,’” continues Dr. Ilyas.

Approximately half of all people with rosacea also develop eye problems or ocular rosacea. (3) “This is a form of rosacea that affects the eyes, and it occurs in about 50 to 70 percent of patients with rosacea,” notes Ilyas. “It may or may not be associated with rosacea of the skin.”

Symptoms of ocular rosacea include chronic tearing and eye dryness, a gritty sensation in the eye, flaking at the base of the eyelashes (called blepharitis), and recurring styes. (4)

People with rosacea typically have sensitive skin and can’t tolerate a variety of skin products. What’s more, rosacea often worsens with certain environmental triggers, including temperature extremes and sun exposure.

Other triggers include emotional stress and certain foods and drinks, such as red wine and spicy dishes. (3)

The exact cause of rosacea is unknown, but scientists do know that the blood vessels within the skin of people with rosacea are unstable and more reactive than those who don’t have the condition. (2,3) Some experts believe rosacea could be due to a dysregulation of the immune system as well as a genetic predisposition.

Also, Demodex mites — microscopic organisms that normally inhabit hair follicles in low numbers — appear to be more numerous in those with rosacea, explains Anna D. Guanche, MD, a board-certified dermatologist based in Calabasas, California. On average, these patients have more Demodex mites per pore, says Dr. Guanche. This may contribute to the red bumps of rosacea.

Skin Conditions That Can Resemble Rosacea

Several other conditions can produce the skin redness and acne-like bumps of rosacea, including the following:

Acne

Acne develops when small pores in your skin become clogged with oil and dead skin cells. Symptoms can vary from person to person, but may include red lumps or spots, tiny white bumps, and dark spots with open pores. (5)

Acne typically occurs in younger people, triggered by hormone fluctuations that cause excess oil secretion. But older people can get zits, too. In fact, some women develop problems with acne in middle age. (5) The telltale sign that distinguishes acne from rosacea is the presence of whiteheads or blackheads, called comedones. Though acne and rosacea can be present at the same time, only acne is associated with comedones.

Lupus

Lupus is another skin condition that can be mistaken for rosacea. This chronic autoimmune disease causes inflammation in different parts of the body, including the skin. (6)

Inflammation results from the immune system attacking healthy cells and tissues. One distinct symptom of lupus is a red, facial rash. This rash can cover both cheeks and usually has a butterfly shape. (7)

Along with rosy cheeks, the rash can cover the bridge of the nose. But while a rosacea rash may look like lupus, the difference is that a lupus rash doesn’t have red bumps that are typical of rosacea, although the rash can be raised. (8)

Other symptoms that may accompany a lupus rash include fever, fatigue, joint pain and stiffness, headache, dry eyes, and shortness of breath.

Seborrheic Dermatitis

This skin condition is often found on the scalp, causing red patches and dandruff. It can also develop on other parts of the body, including the face and the nose, so it’s sometimes mistaken for rosacea. There is, however, a way to tell these conditions apart. (9,10)

In addition to redness, seborrheic dermatitis can cause flaking in the brows, the lower forehead between the eyebrows, the creases around the nose, and sometimes the chin. (10)

If you have seborrheic dermatitis, you won’t have red, swollen bumps or pus-filled pimples that are typical with rosacea. (9)

Keep in mind that it is possible to have seborrheic dermatitis and rosacea at the same time. (10)

Perioral Dermatitis

This type of dermatitis usually manifests as a red rash around the mouth. The rash can make the skin feel scaly, flaky, bumpy, and itchy. It can also spread to the nose and eyes.

It’s most often seen in women ages 25 to 45 who use topical steroids.

Perioral dermatitis can return after treatment, and many repeat cases can turn into rosacea, according to the Cleveland Clinic.

Seeing a Dermatologist for Diagnosis and Care

If you think you have rosacea, don’t ignore the symptoms. While rosacea can’t be cured, treatment can help you manage symptoms and reduce flares. (3)

More important, symptoms can become increasingly worse without intervention, according to the National Rosacea Society.

Seeing a dermatologist is a good first step to get the right diagnosis and appropriate care.

There isn’t a specific laboratory test to diagnose rosacea. Your doctor will examine your skin and eyes, ask about your medical history, and you’ll likely undergo tests to rule out skin conditions with similar symptoms. (11)

Although there are over-the-counter options for treating rosacea, topical and oral prescription medication might do a better job of improving the physical symptoms.

Early diagnosis and treatment are key to stopping the progression of this chronic disease, says Ilyas. If left untreated, facial redness can worsen or become more persistent. But if caught early, rosacea can be controlled. (11)

Becoming aware of — and avoiding — any strong triggers can also keep breakouts and redness under control. (3)

Because rosacea is a chronic condition, redness can return at different points in your life. For this reason, you’ll need to follow up with your doctor periodically to keep skin care on course.