Acne or Rosacea? How to Tell the Difference

Any type of redness, bump, or blemish on your face can make you run for the cover-up. There are clever ways to conceal your skin flaws, but until one of our professionals helps you treat them, you may be stuck in a cycle of hiding from your own skin. 

The first step in your treatment journey? Determining what’s actually going on. 

Those red bumps or irritations on your face are likely either acne or rosacea. Both conditions are common, both affect the skin on the face, and both can look surprisingly similar at first glance. But the way we treat them is very different, which is why it’s important to know which one you’re dealing with.

Our board-certified dermatologists at Sanford Dermatology see patients every week who come in convinced they have acne, only for us to discover it’s rosacea — or the other way around. Read on as we break down the differences, discuss what symptoms to look for, and explain why proper diagnosis matters.

What acne looks like

Acne is one of the most common skin conditions in the world. It usually starts in the teenage years, but plenty of adults get it, too. The hallmark signs are clogged pores that turn into:

• Whiteheads (closed comedones)
• Blackheads (open comedones)
• Papules and pustules (red, inflamed bumps, sometimes with pus)
• Nodules and cysts (larger, deeper, and often painful bumps)

Acne tends to show up where oil glands are most active (across the forehead, nose, chin, chest, and back). Oily skin, hormonal fluctuations, and certain lifestyle factors (like stress or diet) can all make it worse.

The good news is that acne is very treatable with topical creams, oral medications, and lifestyle changes. The tricky part is that rosacea can sometimes mimic the appearance of acne.

What rosacea looks like

Rosacea is a chronic inflammatory condition that usually affects adults, most commonly between the ages of 30 and 50. Unlike acne, rosacea isn’t about clogged pores—it’s more about sensitive blood vessels and an overactive immune response. Common signs include:

• Persistent redness, especially across the cheeks, nose, and forehead
• Visible blood vessels (telangiectasias)
• Flushing or blushing easily
• Red bumps that resemble acne, but don’t have blackheads or whiteheads
• Eye irritation or redness (ocular rosacea)

In some cases, rosacea causes thickening of the skin on the nose (rhinophyma). Unlike acne, rosacea often flares up in response to triggers. Spicy foods, alcohol, hot drinks, stress, sun exposure, or even a change in the weather can all set up a symptom flare.

The key differences

So, how can you tell whether you’re dealing with acne or rosacea? First, we look at the age of onset. Acne often starts in adolescence, while rosacea is more common in adulthood.

Next, we evaluate your skin. Acne produces blackheads and whiteheads — rosacea does not. And while acne can cause red bumps, rosacea tends to cause overall flushing and visible blood vessels.

Another key component in diagnosing your skin condition is determining whether certain triggers exacerbate it. Hormones and oil production influence acne, while rosacea tends to flare with environmental or lifestyle triggers.

It’s also possible to have both conditions at the same time, which can make diagnosis and treatment a bit more complex.

Getting it right matters

Treating rosacea as if it were acne (or vice versa) can actually make things worse. For example, harsh acne treatments that dry out the skin often irritate rosacea. On the other hand, gentle rosacea creams may not be enough to manage true acne.

A close look at your skin, your medical history, and your lifestyle triggers can help us pinpoint what’s really going on.

Our treatment approach

For acne, our advanced treatments typically focus on unclogging pores, reducing oil production, and calming inflammation. Depending on your needs and the severity of your acne, your treatment plan might include:

• Prescription-strength salicylic or azelaic acid ointments
• Removal of whiteheads or blackheads (extractions)
• Topical or oral retinoid medications
• Oral contraceptives (for women) 
• Chemical peels 
• Oral antibiotics
• Laser therapy  

For rosacea, the approach is very different. Treatment often includes:

• Brimonidine gel to reduce redness
• Oral antibiotic medications
• Oral acne drugs, such as isotretinoin 
• Laser therapy

We also have a suite of clinical-grade skincare products you can use at home to minimize redness and irritation. To maximize your treatments, we recommend following these simple at-home skincare rules:

• Wash with a mild, non-foaming cleanser twice a day
• Use sunscreen daily (sun exposure is a big rosacea trigger)
• Avoid skincare products with alcohol, strong fragrances, or abrasive scrubs
• Keep a symptom journal to spot patterns and identify triggers

Small changes can make a big difference, especially when combined with medical treatment.

Taking charge of your skin health

If you’ve been struggling with breakouts or redness that doesn’t seem to improve, don’t just assume it’s acne. Getting the right diagnosis is the first step toward clearer, healthier skin — and we’re here to help. Schedule an appointment at your nearest Sanford Dermatology office in Sanford, Pittsboro, or Lillington, North Carolina, today.