While acne is the most common skin condition worldwide, rosacea is not that frequent and well-known.  They both share similar symptoms and are often mistaken, but they are totally different disorders. This article looks at the causes, similarities, differences, and treatment of acne and rosacea. So, which one do you have? Let’s compare acne vs. rosacea.

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Acne vs. Rosacea

Acne vulgaris is a medical term for acne, pimples, blackheads, acne cysts, etc. Some people experience non-inflammatory acne, such as whiteheads and blackheads, and some have inflammatory lesions (papules, pustules, nodules, and cysts).

Image comparing acne vs. rosacea: two girls, one with acne, the other with rosacea.
Acne vs. Rosacea (Shutterstock)

Hormonal imbalances usually cause acne in women and men, more often in those undergoing major hormonal shifts: adolescence, pregnancy, stopping birth control, having an IUD (intrauterine device), menopause, and others. Also, acne is a multifactorial disease caused by many triggers, such as the sun, comedogenic cosmetics, the wrong diet, and other surprising acne causes.

Rosacea, previously called acne rosacea, causes facial redness and, in more severe cases – face redness AND pimples. It affects middle-aged or older women more often than men (children may also develop rosacea). Rosacea on face symptoms include:

  • Flushing, facial redness, burning sensation;
  • Small capillaries, telangiectasias, spider veins;
  • Pimples;
  • Swollen nose (rhinophyma), ears, or chin;
  • Thick skin on the forehead, cheeks, and chin;
  • Red, dry eyes, blurred vision, swollen red eyelids, sensitivity to light, recurrent eye infections, loss of lashes in ocular rosacea.

Illustration "Signs of Rosacea"
Signs of Rosacea (Shutterstock)

There are no clear causes of rosacea. It might run in families; the overreacted immune system may play a role. It was also estimated that people with rosacea tend to test positive for Helicobacter pylori bacteria. More about it in this article on H. pylori.

Also, people with fair skin tend to develop rosacea more often. Some factors, such as hot or alcoholic drinks, spicy foods, wind, or emotions, might trigger flushing.

Rosacea might also be mistaken for seborrheic dermatitis. Check this article on rosacea vs. seborrheic dermatitis.

Papulopustular Rosacea vs. Acne

Both conditions involve pimples, such as papules or pustules, but the causes are different for each.

Hormonal changes, the rise of testosterone, and other androgens stimulate oil glands to produce more sebum, leading to acne pimples (despite gender). Physiological changes in hormonal balance during puberty or pregnancy may lead to acne breakouts, as well as some disorders that cause high testosterone in women regardless of physiological changes.

Excessive oil production leads to the growth of acne bacteria that cause inflammatory acne. But besides inflammatory lesions, comedones (whiteheads and blackheads) are also often found in people with acne.

Hormonal acne flares on the jawlineYoung woman with rosacea
Acne vs. Rosacea (Getty Images, Shutterstock)

In rosacea, mites, known as Demodex, are involved. Persistent facial redness and dilated vessels cause skin burning sensation and increased skin temperature. This is a perfect environment for mites: warm and cozy.

Demodex mites are very tiny (0,15 – 0,4 mm), live in hair follicles near oil glands, and eat sebum (oil).

Demodex Mites That Live in Hair Follicles (Essential Collection via Getty Images)

Demodex mites are not rare. In fact, they are more common than you think. Children usually do not have these mites, but 84% of people over 60 years and 100% of the population over 70 have them (3). It means Demodex infestation increases with age!

But this does not mean everybody after 70 years will develop rosacea. Demodex mites are common, but their caused disorder (demodicosis, or papulopustular rosacea) is rare!

Demodex mites in the hair follicle
Demodex Mites in the Hair Follicle (Essential Collection via Getty Images)

Demodex mites damage hair follicles and oil glands, thus causing acne-like pimples on the face.

Acne vs. Rosacea Location

Acne affects body parts with the most significant density of oil glands: the face, chest, and back.

On the other hand, rosacea affects ONLY the face. But unlike acne, rosacea may affect the eyes, eyelids, and vision.

Acne vs. Rosacea: Do They Go Away?

Teenage acne may go away after hormones settle down; pregnancy acne usually vanishes after the baby is born, but some health conditions, such as PCOS (polycystic ovary syndrome), insulin resistance, or adrenal hyperplasia, need treatment.

Rosacea is a persistent condition. It is possible to clear it out by choosing the proper treatment. Treatment will control rosacea and reduce symptoms and pimples, but rosacea might come back after stopping treatment.

Acne vs. Rosacea: How Are They Diagnosed?

Acne is usually diagnosed just by observation and looking at the skin. Blood tests may also be performed to estimate hormonal imbalance or the lack of essential nutrients and vitamins.

Rosacea can also be diagnosed by examining the face’s skin. Demodex mites are diagnosed by scraping the top of the skin or performing a skin biopsy when a physician takes a skin sample and examines it under a microscope. Dermoscopy using a particular magnifying device can also find mites.

Demodex mite under microscope
Demodex Mite from a Microscope View (Essential Collection via Getty Images)

ONLY no diagnostic procedure can be sure you do not have mites. If the procedure did not find Demodex mites, it does not mean you don’t have them.

Acne vs. Rosacea: How Are They Treated?

Acne is a multifactorial disease, and many things may cause acne. Treatment is also focused on many steps: balancing hormones and supplementing the lack of vitamins, performing chemical peels, and establishing a skincare routine. Many treatment options are covered in this ultimate guide and also here.

PAPULOPUSTULAR ROSACEA requires eliminating Demodex mites. Treatment should include acaricide, a pesticide that kills mites. Many ingredients may work as an acaricide: permethrin, metronidazole, ivermectin, my all-time favorite salicylic acid or azelaic acid, sulfur ingredients, selenium sulfide, and others.

Similarities acne vs. rosacea: a young woman with papulopustular rosacea, looks very similar to acne
Papulopustular Rosacea (Essential Collection via Getty Images)

The health care provider may prescribe a cream, lotion, or wash containing one of these ingredients. Ivermectin may be prescribed to take orally, and it shows the most effective results.

You may also perform a salicylic or azelaic acid chemical peel in the office. Salicylic acid peel benefits papulopustular rosacea and rosacea pimples as it can kill Demodex mites and has an anti-inflammatory effect.

Topical azelaic acid gel or topical metronidazole are also used to treat papulopustular rosacea and pimples. Also, isotretinoin looks like an excellent alternative to treat rosacea at home. It reduces the oil glands and sebum production, narrows the hair follicle’s entrance, and creates a not-so-favorable environment for Demodex mites.

One more option – a novelty – encapsulated benzoyl peroxide might help. It will work slowly, releasing benzoyl peroxide over time, and will not be harsh on sensitive rosacea skin.

Tee tree oil in an ointment might help with ocular demodicosis. Just be sure not to use tea tree oil alone as it might irritate the eyes. Oral doxycycline and topical azithromycin are also helpful for ocular rosacea.

ERYTHEMATOUS ROSACEA is characterized by facial redness, flushing, burning sensation, and spider veins and does not show any pimples. Treatment is a little different from the one for papulopustular rosacea. Facial erythema may be reduced using topical brimonidine, oxymetazoline, or systemic carvedilol. Topical azelaic acid and metronidazole are also beneficial, reduce erythema, and are well tolerated by the patients.

Acne vs. Rosacea: a woman with erythematous rosacea
Erythematous Rosacea (Shutterstock)

Pulsed light and diode laser treatments improve vessels and telangiectasias (spider veins) but are expensive and must often be repeated.

Medical-grade chemical peels, especially azelaic acid peels, are often helpful.

If your rosacea is starting and there is no need for medical help, try cosmetic products containing azelaic acid, blood vessel strengthening, and calming ingredients, such as vitamin C products, Centella Asiatica, green tea, ginger, Ginkgo, ceramides, niacinamide (vitamin B3), aloe vera, colloidal oatmeal, cucumber, allantoin, and panthenol.

Color-correcting creams and powders, green concealers, and powders that hide redness can be helpful.

Do not forget to hydrate and nourish your skin because proper skin barrier plays one of the significant roles in rosacea development pathways.

Finally, avoid triggering factors, such as heat, alcoholic beverages, hot drinks, stress, wind, and spicy foods. Wear broad-spectrum sunscreen to protect your sensitive skin and prevent rosacea-triggering UV rays.


In this article, we have talked about many aspects of acne vs. rosacea.

Acne is usually caused by hormonal disbalances, lack of some essential nutrients and vitamins, comedogenic cosmetics, and other factors.

Rosacea’s clear causes are still unknown. Heredity, triggering factors (wind, heat, spicy foods, alcoholic beverages, hot drinks), and Demodex mites play a significant role in rosacea.

Acne may affect the face, chest, and back; rosacea affects only the face.

The most common rosacea symptoms include facial redness, prominent vessels, spider veins, pimples (papules and pustules and no blackheads or whiteheads as in acne), rough solid skin on the forehead, chin, and cheeks, swollen nose or ears, ocular symptoms (swollen red eyelids, blurred vision, recurring eye or eyelid infections).

While acne is treated by balancing hormones, reducing androgens, establishing a skincare routine, and performing facials and chemical peels in the office, the most important treatment for rosacea is strengthening blood vessels (from cosmetics to laser treatment) and killing Demodex mites (from antibiotics to acaricides).

Rosacea is a persistent condition but can be controlled and symptoms cleared with proper treatment!

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  1. Forton FMN. Rosacea, an infectious disease: why rosacea with papulopustules should be considered a demodicosis. A narrative review. J Eur Acad Dermatol Venereol 2022 Jul;36(7):987-1002. doi: 10.1111/jdv.18049. Epub 2022 Mar 31. Read
  2. Zhou M, Xie H, Cheng L, Li J. Clinical characteristics and epidermal barrier function of papulopustular rosacea: a comparison study with acne vulgaris. Pak J Med Sci 2016;32(6):1344-1348. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5216279/
  3. Li J, Luo X, Liao Y, Liang L. Age differences in ocular demodicosis: Demodex profiles and clinical manifestations. Ann Transl Med. 2021 May;9(9):791. PMID: 34268404; PMCID: PMC8246181; https://atm.amegroups.com/article/view/65995/html
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