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Rosacea with Acne – Causes, Treatment and Home Remedies

Rosacea and Acne are 2 different skin conditions although it is difficult to differentiate between the two. The causes and trigger factors for each of these conditions differ. Therefore home remedies and treatments are also different.

Rosacea and Acne can sometimes co-exist. In this instance treatment should aim at focusing both skin conditions separately as well as together as it is the same person who suffers from both these conditions. Sometimes medications used to treat acne can worsen Rosacea. However it is best to use products which treat both skin conditions as well as medications to treat individual skin conditions.

There is a subtype of Rosacea (papulo-pustular type) which resembles Acne like breakouts and often it may be confused with coexistence of Rosacea and Acne. However, your dermatologist should be able to correctly identify and treat the condition as Rosacea.

What is Rosacea?

Rosacea is a common skin condition. It usually begins with a tendency to flush or blush more easily than others. Redness commonly starts in the center part of the face involving the nose and cheeks. This can spread towards chin and forehead. Sometimes ears, chest and back can also get involved and become red.

This redness will become permanent with time. Rosacea is not only redness, but it may also give rise to red, small pus filled bumps (lesions like pimples). Although Rosacea can arise in anyone, it is commonly seen in middle aged women with fair skin.

According to American academy of Dermatology (AAD), Rosacea can be categorized in to four sub types according to the signs and symptoms. They are:

Erythemato-telangiectatic rosacea: flushing, Redness, blood vessels are visible
Papulo-pustular rosacea: Acne-like breakouts with redness and swelling
Phymatous rosacea: Skin is thickened and has a bumpy surface
Ocular rosacea: Eyes are red and irritated, eyelids may swell up and sty like lesions can appear

If you suffer from Rosacea, do not get distressed because you are not alone. Even famous personalities like princess Diana had and Bill Clinton still suffer from Rosacea.

Rosacea can be misdiagnosed for Acne or allergic reactions causing redness.

How do you identify that you are having Rosacea?

Following signs and symptoms can help you to identify Rosacea.

Redness – persistent redness mainly occurs in the center part of the face and may spread outwards. That is redness will start from nose and cheeks and may spread towards chin and fore head. Small blood vessels on your nose and cheeks can get swollen and more visible.
Pimples – People with Rosacea commonly develop swollen red bumps which resemble acne. These red bumps can become yellow as they are filled with pus.
Hot tender skin – This is because the blood vessels in the skin are enlarged. When the blood supply is more, the skin may feel hot and tender.
Prominent nose – When Rosacea thickens the skin on the nose, it can appear enlarged. This is called Rhinophyma. Enlarged nose is a common feature in men with Rosacea than in women. Rhinophyma is rather a complication of Rosacea as it occurs slowly over a period of time.
Eye problems – 50% of people with Rosacea have eye symptoms like dry eyes, irritability, swollen eyes, reddish eye lids and stys etc.

What are the causes of Rosacea?

The exact cause of Rosacea is unknown. It is thought to be a combination of genetic (hereditary) and environmental factors. Rosacea is not a result of poor hygiene, which is a common myth.

If you are a woman, you are more likely to develop Rosacea than a man. If you are above 30 years of age, you are more prone to develop Rosacea than a younger person.

If you have fair skin, it can get easily damaged by sun exposure. Thus people with fairer skin are more prone to develop Rosacea than dark individuals. The pigment Melanin in dark skin protects the skin from sun damage.

Smoking is a risk factor for so many diseases and Rosacea is one of the many skin conditions which is triggered by smoking. Therefore smokers suffer more than non- smokers with regards to Rosacea.

If you have a close relative or a family member who suffers from it, your risk is higher to develop it than those who do not have a family history.

What are the risk factors which can trigger Rosacea?

Rosacea with Acne - Causes, Treatment and Remedies

Following factors are known to aggravate Rosacea and are identified as trigger factors. They are known to increase the blood flow to the surface of your skin by dilating the blood vessels.

Ex: Spicy foods, alcohol, hot drinks

Exercise will also dilate the surface blood vessel and cause increase blood flow to your skin.

Certain weather conditions can act as triggers for Rosacea. Heat is well known to dilate blood vessels. Ex: Extremes of temperature, too much sun exposure and strong winds.

When you are emotionally upset, anxious, embarrassed or scared the blood flow to your face can increase, which in turn can aggravate Rosacea. Anxiety symptoms mentioned above will make your body release the hormone Adrenaline. As a result, blood vessels on your face dilate and allow more blood flow than usual, thus making the face, especially cheeks turning red.

There are certain cosmetics and make up products which have various chemicals, can give rise to flare ups to Rosacea prone skin because their skin is more sensitive. There are drugs which are known to dilate blood vessels (vasodilators). Some of these are used to treat patients with high blood pressure. Ex: Captopril, Losartan, Amlodipine etc. If your skin is prone to develop Rosacea, using these medications can give rise to flares.

There is no cure for Rosacea, however; with proper treatment and home remedies it can be controlled.

What is Acne?

Acne is a skin condition where the hair follicles of your skin become plugged with oil and dead skin cells. It can have black heads (open comedones), white heads (closed comedones) and pimples.

Acne is commonly seen on face, fore head, chest, shoulders and upper back. Acne can develop scarring especially when you squeeze them out. When Acne is severe, large nodules and pus filled cysts can appear. This can be very distressing to the sufferer.

What are the causes of Acne?

Bacteria on skin – There is a bacterium called Propieno-bacterium acne which proliferates on skin and cause acne. This bacterium is normally found in skin. It multiplies in trapped sebum.
Excessive oil (sebum) production – When sebaceous glands (oil producing glands) are overly active they produce excess oils which can cause and worsen Acne.
Clogged hair follicles – The hair follicles can be clogged by dead skin cells and of course excess oil.
Excessive androgen activity – When you have excessive production of androgenic hormones such as testosterone, you can develop acne as a result. Androgen hormones can increase during puberty. That’s why both girls and boys tend to develop Acne during their pubertal years. Androgens make the sebaceous glands enlarge which then produce more sebum (oil). Excessive testosterone production can occur in conditions like poly cystic ovarian disease (PCOD) in women. Therefore women who suffer from Poly cystic ovarian disease will commonly have acne as a complication.
Stress – Stress can worsen acne because during stressful periods your body can produce the hormone cortisol which can give rise to acne. There are also excessive steroid producing illnesses like Cushing syndrome which can give rise to acne.
Certain medications like drugs containing testosterone, corticosteroids and lithium can aggravate acne. Some contraceptive pills and certain medications used for epilepsy, steroids used as medication for various illnesses can cause acne. If you are on one or more of these medications and Acne becomes problematic to you, discuss this with your doctor because then he should be able to alter the medications which have less side effects.
There are some researches where certain foods are identified as risk factors for worsening acne, such as skimmed milk, chocolate, fatty foods and carbohydrate rich foods. If you consume these items excessively, it is time to think whether you would reduce consumption or live with Acne.
Greasy or poor quality make up products can block skin pores and cause acne.

Although Rosacea is more common in middle aged people especially women, acne is more common in teenagers. Acne is commonly seen in 15 to 25 year age group.

What are the symptoms and signs of a face with Acne?

Greasy or oily looking skin
Black heads (open comedones)
White heads (closed comodones)
Red or yellow spots (papules or pustules)
Deep inflamed lesions (nodules and cysts) in severe acne
Scars – when acne is broken manually and squeezed out a deep scar can occur

Rosacea and Acne (commonly known as acne vulgaris) are 2 different skin conditions and as you can see, the causes for both are entirely different, although they look alike and can be misdiagnosed.

Many people who suffer from Rosacea develop pimples on their faces which resemble Acne. Those days Rosacea was also known as Rosacea acne which is now considered a misnomer. However Rosacea and Acne can co –exist in the same individual. This condition is called Rosacea with Acne.

What are the differences of Rosacea and Acne?

Although Rosacea and Acne look so much alike, when you look closely you may notice that black heads and white heads are only found in acne. Persistent redness and flushing is a hall mark of Rosacea. But inflammation can give rise to temporary areas of redness in acne.

Treatment of Rosacea with Acne

Acne and Rosacea are 2 different skin conditions although they co- exist, they require different treatments. Sometimes medications used to treat acne can worsen Rosacea.

However it is best to use products which treat both skin conditions as well as medications to treat individual skin conditions.

What is the treatment for Acne?

Inflamed acne needs to be treated early to prevent scarring. With time Acne settles and total control can be achieved.

However if your skin is prone to Acne, having risk factors cam give rise to occasional break outs.

What are the home remedies which you can try before seeking medical treatment?

Wash your face and other areas with affected with acne twice daily with luke warm water. You can use a suitable face wash or a mild soap. Very hot or cold water can worsen acne.

Do not scrub when washing acne affected skin because excessive washing and scrubbing can increase inflammation and can worsen acne. Do not use greasy creams or poor quality make up as it may clog pores.

If home remedies do not work, always seek treatment from a qualified medical practitioner or a dermatologist. The treatment will depend on the type and severity of acne that you have.

How will your doctor treat Acne?

There are various gels and creams which are used to treat Acne.

Ex. Retinoid gels, Benzoyl peroxide (which comes in 2.5%, 5% and 10%) and topical antibiotic gels. There are also combinations which are proven to be effective against acne.

Sometimes you will be prescribed with a course of oral antibiotics like doxycycline if acne is severe. This course may need to be continued for about 3 to 6 months depending on the response. Usually it takes time for acne to clear with any form of treatment (usually 4-6 weeks). Therefore it is very important to be patient and follow medications as instructed.

There are newer methods like LASER treatment, subcision and chemical peeling for scarred skin due to acne. These specialized treatments should be done by a qualified practitioner.

Even after successful treatment acne can flare up again in some due to various conditions.

How do we prevent getting Acne?

Avoid eating excessive amounts of carbs, chocolates and sugary foods
Avoid eating or drinking excessive amounts of dairy products or skimmed milk
Avoid stress – practice relaxation techniques such as yoga and meditation
Proper personal hygiene – Wash hair regularly to prevent dandruff as when dandruff when falls on to face can lead to acne, keep skin clean, use a good face wash or a cleanser to control and wash off excessive oils on skin
Use quality creams and make up products which suits your skin type
After using make up cleanse the face well. If makeup is kept overnight, it can clog skin pores leading to acne break outs.
Avoid using greasy creams which can clog pores.

How do you treat Rosacea?

Treatment of Rosacea is focused on preventing blood vessel dilatation on skin. There is no cure for Rosacea. However, with proper treatment and home remedies it can be controlled.

What are the home remedies which can be tried to treat Rosacea?

Rosacea is a common skin condition and because of persistent redness, blemishing and swelling around your cheeks and nose, it may become a cosmetic concern to you which can lead to emotional distress.

It is good to identify what triggers Rosacea in you. Many people will have different triggering factors. Learning what your particular triggers are will help treating Rosacea easily.

Eliminating those which aggravate your skin condition will help immensely. They may be your cosmetics, make up, lotions, skin exfolients which may be too harsh for your sensitive skin. The reason may be certain foods which contribute to digestive issues or may even cause allergies.

Sun protection – Always use a good sunscreen whenever you go out in the sun. Sun damage correlates highly with the severity of symptoms due to Rosacea. Use a sun block which is SPF 30 – 50, with minimal chemicals as possible. Protecting your skin from harmful sun rays will help prevent symptoms from worsening, while redness and inflammation will also decrease.
Healthy diet plan – If you have a nutritious and a balanced diet plan, it will help you towards controlling not only Rosacea but also Acne. Avoid those foods that trigger Rosacea such as spicy foods, hot drinks and alcohol.

Include plenty of vegetables, fruits and green leaves into your diet. Greens and yellow / orange fruits contain carotenoid phytonutrients. Ex: carrots, papaya, pumpkin

Carotenoid is a plant chemical (phytonutrient) which acts as an antioxidant that deactivates free radicals damaging skin. They also have anti-inflammatory properties which fight against Acne and Rosacea.

Include healthy fats – Olive oil, fish oil, coconut oil, fruits like Avocado and nuts will help with natural stress management, digestion and regulation of your hormones.

Include lean proteins – eggs and fish are known to improve your immune system and fight against inflammation.

There are certain foods which are known to have anti-inflammatory properties such as ginger, garlic, onions, turmeric, broccoli and collard greens. Include them in your daily meals while cooking. Drinking green tea is also known to reduce skin inflammation.

Try to avoid allergens like dairy, gluten, sugar and fried foods as they are known to increase inflammation and irritation of your skin.

Keep skin well hydrated. Drinking water and preventing dehydration helps to wash out toxins which can otherwise clog your skin.

Ice water – using ice water packs on your skin can cool the surface and keep blood vessels from dilating. You can try this once daily to reduce redness.

Selection of cosmetics – switch to gentle formulas and good quality cosmetic products. Try to go out without makeup occasionally, which will allow your skin to breathe. If you prefer to cover up your Rosacea with a foundation or a powder, make sure you use a good quality product which suits your skin. All traces of makeup should be removed with a good cleanser before you sleep, as leaving makeup on your skin for prolonged periods can worsen your Rosacea.

Stress reduction – Manage your stresses well. Stress is known to worsen both Acne and Rosacea. Our bodies react negatively while under stress and make you more prone to allergies, irritation, inflammation and breakouts. Engage in relaxation techniques such as yoga and meditation. Take time regularly to do activities which make you happy such as creative activities like art and music which will help you to relieve stress.

Essential oils – Aromatherapy with essential oils may be beneficial because of their anti-inflammatory properties.

Ex: Tea tree, chamomile, lavender and Eucalyptus

You can put a dab of your favorite essential oil on the inside of your wrists before you sleep, lets you breathe in the freshness. This will reduce your stress as well as fight against inflammation.

When should you seek help from your doctor?

When your Rosacea worsens with time and it doesn’t respond to home remedies
When you are distressed about your skin condition and it affects your day to day activities

Your doctor will assess your skin condition and severity before starting treatment. If your eyes are affected you will be referred to an eye specialist (ophthalmologist).

As Rosacea cannot be cured, treatment will focus on controlling your signs and symptoms. It includes a good skin care routine and prescription treatment. The duration of treatment depends on the type and severity of your symptoms. However well your symptoms are controlled, recurrence is common.

Treatment options for Rosacea include:

Oral antibiotics – Antibiotics fight against the bacteria which causes inflammation. Doxycycline is a commonly used antibiotic for both moderate to severe Acne and Rosacea with pustules.
Isotretinoin – Helps to treat Acne as well as Acne like lesions in Rosacea.
Medications to reduce redness – These drugs constrict blood vessels on skin when applied regularly, thus reducing the redness.
Topical application of Azelaic acid and Metronidazole gels can be used to reduce pimples and redness in both mild forms of Rosacea and Acne.

These treatments to cause action take time. You have to be patient and follow up with your doctor regularly to maintain control of your skin condition.

Newer therapies to reduce redness due to enlarged blood vessels are LASER therapy, Dermabrasion, Intense pulsed Light therapy and Electro-surgery. These should be done in specialized centers by qualified personnel.

Coping and supporting

Rosacea with Acne can be really distressing especially if you are worried about your appearance. Do not be frustrated or self- conscious, especially when reactions of other people affect you.

Accept the condition and positively work towards achieving control. Talking to a counselor about your feelings will be helpful.

Conclusion

Both Acne and Rosacea are skin conditions which are chronic and cannot be cured completely. They can be successfully controlled with proper medication, self – care and home remedies. However in the presence of various trigger factors, both Acne and Rosacea can flare up which can cause a fair amount of distress to you.

Therefore it is important to be followed up with your doctor and follow instructions accordingly. Acne and Rosacea although look similar in signs and symptoms, they are 2 different skin conditions. The causes are different as well as the treatments.

When Rosacea and Acne co-exist, the treatment should be done in such a way that both conditions are treated and treatment of one condition may not aggravate the other.

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