Acne (acne vulgaris) often has its onset around puberty, may be very active in teenagers, and may persist or develop in adults — especially women. Lesions consist of clogged pores (blackheads and whiteheads), pustules, red bumps (papules) and tender deeper cysts. Acne vulgaris occurs on the face, neck, shoulders, and trunk. Underlying mechanisms include hormonal changes leading to increased oil production, and bacteria leading to inflammation and clogged pores. Together, these result in acne lesions. There is a strong genetic component to acne vulgaris. Adult onset acne most often affects women between the ages of 20 and 50. They often experience hormonally based lesions, particularly pink papules and painful cysts along the jaw line and lower face.
Acne rosacea is most common in adults between the ages of 30 and 60, and is more common in women. It primarily involves the central face and consists of four stages: flushing; redness/small vessels; red bumps and pustules; and less commonly, skin swelling/thickening. It is most common in fair-skinned individuals. The underlying cause of rosacea is not well understood. Recently, it has been thought to be a combination of dysregulation in the skin’s nervous and blood vessel systems and localized immune system dysfunction that leads to inflammation, redness, and subsequent lesions. Risk factors include sun exposure, family history, possibly Demodex mites and/or Helicobacter pylori. Additional factors that aggravate the redness of rosacea include alcohol, caffeine, heat exposure, and smoking.
To distinguish between acne and rosacea, it is helpful to consider the following information: age; the location and type of lesions; and the degree of underlying redness. Teen years, clogged pores/blackheads, and trunk involvement are seen primarily in acne vulgaris. Central facial redness with or without pink bumps and pustules are more suggestive of acne rosacea.