There are nearly 3,000 skin disorders known in dermatology, two of the most common being acne and rosacea. A staggering 95 percent of people aged 11-30 are affected by acne in some way, and around 1 in 10 people in the UK are affected by rosacea, which means most people have been impacted by either condition at some point in their life. But what if we told you that you might actually have a form of both conditions? Papulopustular rosacea, commonly known as acne rosacea, features characteristics of both rosacea and acne, forming an entirely different condition altogether.
Papulopustular rosacea can often look very similar to acne, resulting in a misdiagnosis. “I often see patients with acne rosacea, which has been misdiagnosed as acne,” says Dr Sophie Shotter, a cosmetic doctor and founder of Illuminate Skin Clinic “The unfortunate thing is that the treatment for the two conditions is very different,” she adds.
This is something I know all too well. Until a recent diagnosis of acne rosacea by Dr Shotter, I was trying to treat my irritated skin and blemishes with common acne treatments and strong ingredients – I’m still wincing at the thought of it.
To break down everything you need to know about papulopustular rosacea, we spoke to four leading dermatologists to find out what it is, what triggers it, and what you can do to treat it (spoiler alert: there’s quite a bit).
What Is Papulopustular Rosacea?
Papulopustular rosacea has many of the same symptoms regular rosacea does: “The skin is extra sensitive and over-reactive to the environment and you may develop redness and flush easily, in addition to experiencing a burning and stinging sensation”, says New York City-based dermatologist Joshua Zeichner. With acne rosacea, you’re likely to also experience “red papules (raised and often red bumps) or pustules (bumps containing pus), which can give the appearance of acne”, says Dr Susan Mayou, consultant dermatologist at London’s Cadogan Clinic. Unlike regular acne, however, with papulopustular rosacea, you’re unlikely to see blackheads.
Another way of detecting acne rosacea is identifying where it manifests. “The rash and irritation typically affects the middle third of the face”, says Dr Zeichner, commonly affecting the cheeks, bridge of the nose, and the chin.
What’s the Difference Between Acne and Rosacea?
First and foremost, determining the difference between acne and rosacea is key. “Acne and rosacea can be mistaken for each other, but it is important to determine the difference as treatment of one may make the other worse,” says consultant dermatologist Dr Emma Craythorne.
“Rosacea is a disease of the skin barrier, which becomes impaired by many different possible causes, explains Dr Shotter, meaning that if you have rosacea, your skin is weaker and sensitised. “Acne, on the other hand, is a disease of the pilosebaceous unit – the structure consisting of hair, hair follicle, and sebaceous gland – and skin is usually oily and more resilient,” says Dr Shotter, adding that, “in rosacea, small inflamed bumps will appear alongside other symptoms such as redness, sensitivity, and dilated blood vessels. Whereas in acne, the skin will contain a variety of lesions such as blackheads and white heads, as well as red bumps.”
What Triggers Papulopustular Rosacea?
As with many skin conditions, it isn’t known exactly what causes acne papulopustular rosacea, though there are common triggers to look out for. “To find your triggers, you’ll have to do a bit of detective work, but a good place to start is looking into common triggers”, says Dr Craythorne. These can include:
- Spicy food
- Hot drinks
- Hot and cold weather
- Certain cosmetic products
- Some medicines
In short: acne rosacea can be triggered by a lot of things. Keeping track of your symptoms and when they arise can help track down what your triggers are and how to keep reactions and irritations at bay.
Treatments For Papulopustular Rosacea
If you suspect you have papulopustular rosacea, the best thing to do is to visit your GP or a dermatologist, as distinguishing between the two really needs a trained eye. “Papulopustular rosacea requires a professional diagnosis so correct treatment can be given.” says Dr Mayou.
Despite there being lots of different treatment options out there for papulopustular rosacea depending on what your symptoms are, Dr Craythorne says one thing people with any rosacea-related condition should do is to: “keep it simple, keep it repetitive, and keep it gentle” with their skincare routine.
When it comes to specific skincare ingredients “using strong topical ingredients designed for acne-prone skin – like salicylic acid and benzoyl peroxide – on rosacea-prone skin will increase the flare up rather than improving it”, says Dr Shotter. Dr Craythorne also advises patients to avoid toners, alpha hydroxy acids, fragrances, scrubs and exfoliators, as well as hot water. However tempting it may be to slap on the harshest acne treatment you can find when inflammation or breakouts crop it, just don’t do it – it will likely exacerbate the skin condition.
Instead, Dr Zeichner approaches treatment for acne rosacea from two angles. “First, you want to keep the skin barrier in as good shape as possible with gentle cleansers and moisturisers. Second, you want to reduce skin inflammation”. To do this, he recommends sticking to hydrating cleansers and ultra calming moisturisers, which protects the skin barrier. Dr Shotter follows the same school of thought for her clients, “rosacea patients need products aimed at barrier repair, which contain gentle ingredients such as poly hydroxy acids and ceramides”, she explains.
Unsurprisingly all of the experts recommend using an SPF every single day. Yep, even when you’re indoors. Sticking to a mineral-based sunscreen will likely cause less irritation than a chemical sunscreen, as it sits on top of the skin rather than soaking into it. “Patients with rosacea tend to have more sensitive skin, then other people, so I recommend his zinc oxide-based sunscreen” explains Dr Zeichner.
In addition to a good skincare routine, Dr Shotter explains that antibiotics either topically or orally are sometimes used to treat papulopustular rosacea (hence why it’s best to see doctor). If you aren’t able to see a dermatologist or are worried about the costs of expert advice, consider trying an online dermatologist service such as Dermatica or Get Harley.
For my rosacea, Dr Shotter and I may look into antibiotic treatment with links to helicobacter pylori, a type of bacteria which can be linked with papulopustular rosacea. Another oral medication used to treat papulopustular rosacea is oracea (otherwise known as doxycycline), which treats bumps and pus pimples. As for topical treatments, Soolantra and Finacea creams work to address bumps and pus spots, while Rhofade, a topical prescription cream, helps to treat facial redness, says Dr Zeichner. Further down the line of treatment, he also explains that you can also look into eliminating any unwanted redness and broken capillaries using laser treatments.