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Rosacea and Adult Acne

You survived adolescence, with its pitfalls and pinnacles. You're free of the trials and tribulations of your early 20s. But on the road of life, other hazards loom—rosacea and adult acne, which can plague even the most timeworn skin. And you thought you'd seen your last blemish.


Rosacea is a chronic skin condition that affects the blood vessels and sebaceous glands of the face. The sebaceous glands produce an oily substance called sebum. Rosacea causes redness, tiny bumps or pimples, and small blood vessels to appear on the cheeks and nose. Occasionally the eyelids may be affected, becoming red and swollen.

In more severe cases, the sebaceous glands enlarge, causing the nose to become bulbous and the cheeks to appear puffy. The lower part of the nose may develop thick bumps; these bumps may also appear on the cheeks. This is more common among men than women.

Most common age range

Rosacea affects about 14 million American adults, particularly fair-skinned people between ages 30 and 50. It is most common in people of Celtic origin. Women tend to develop rosacea more often than men, but the condition is often more severe in men. It can be confused with adult acne, but in rosacea there are no blackheads (comedones), and adult acne does not cause flushing.

Rosacea can cause permanent damage to facial tissue. Early signs of rosacea include a tendency to flush easily. The redness becomes more persistent, and eventually tiny blood vessels or pimples appear. If the eyes are involved, the affected area is usually confined to the eyelids; only rarely is the surface of the eyes affected. Symptoms of ocular rosacea (conjunctivitis). If you notice symptoms, see your doctor. Once diagnosed, rosacea can be treated.

Rosacea triggers

The exact cause of rosacea is unknown; however, certain things can cause the face to flush and that can make rosacea worse:

  • Sunlight and temperature extremes

  • Stress, anger, or excitement

  • Hot drinks and hot foods, spicy foods, and alcohol

  • Irritating cosmetics and other facial products

  • Strenuous exercise

  • Certain medications

Avoiding these risk factors may help lessen symptoms. Your doctor also may recommend certain soaps, moisturizers, and sunscreen products to improve the condition.

Topical antibiotics such as metronidazole are often necessary to help clear symptoms of rosacea. Oral antibiotics such as tetracycline, doxycycline, metronidazole, or monocycline may be needed in some cases. Under some conditions, a medication called Accutane or a topical retinoid cream may be prescribed. Laser surgery may be used to reduce blood vessels and swelling. The most successful treatment will likely be a combination of medication and self-care. Remember, rosacea can get worse without treatment and will most likely come back if you stop treatment.

Adult acne

About one in five adults between ages 25 and 44 has mild to moderate acne. Blemishes can form on your face, neck, chest, back, shoulders, and upper arms. In severe cases, acne may cause scarring.

Acne is a disease of the skin that involves the sebaceous glands and the hair follicles to which they are connected. The oil glands and hair follicles (together called pilosebaceous units) are most numerous on the face, upper back, and chest, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). The sebum produced by the glands normally empties onto the skin surface through the follicles pore. Sometimes a plug of hair and sebum may form in the follicle. Bacteria normally found on the skin can grow in the plugged up follicle and cause inflammation. When the wall of the plugged follicle breaks down, sebum, shed skin cells, and bacteria spill into the nearby skin, leading to pimples or lesions, the NIAMS says.

Types of lesions

Lesions can come in several varieties, according to the NIAMS:

  • Comedo. This is an enlarged and plugged hair follicle. A comedo may stay closed, beneath the skin, producing a white bump called a whitehead. A comedo may also reach the skin surface and open up to make a blackhead. The black color is not because of dirt, but results when fatty material is oxidized to a dark color.

  • Papules. These are inflamed lesions that look like small, tender pink bumps on the skin.

  • Pustules. These are another name for pimples. Pustules are papules topped by pus-filled lesions.

  • Nodules. These are large, painful solid lesions deep in the skin.

  • Cysts. These are deep, painful, pus-filled lesions.

No one knows exactly what causes acne. Possible causes include hormonal changes, stress, heredity, bacteria buildup on the skin, and some medications. Your diet does not cause acne, nor does dirt. In fact, if you wash your face too vigorously or too often, you may worsen acne.

There are things you can do to help control acne. Wash your skin with a mild cleanser or soap in the morning and evening, and after strenuous exercise. Rinse thoroughly. Don't use astringents, facial scrubs, or masks, which can irritate your skin and make acne worse. If you use cosmetics, look for products that are oil-free and formulated to not cause acne. These products are labeled noncomedogenic, meaning they don't promote the formation of closed skin pores. Use oil-free moisturizer, sunscreen, and foundation. Regularly shampoo your hair. If you have oily hair, you may want to shampoo it every day. If the hair care products you use are oily, they should be kept away from the face.

If you are a man with acne, try both an electric and safety razor to see which is better for you. If you use a safety razor, keep the blade sharp and soften your beard with soap and water before using shaving cream. Try to shave lightly and only when necessary, the NIAMS says.

Ideas for self-treatment

For mild acne, self-treatment is frequently adequate. Benzoyl peroxide creams and gels also may be beneficial. Benzoyl peroxide is available over the counter in lower concentrations than in the prescription form.

For a serious case of acne, you should see your doctor. Topical creams and lotions, products that help unblock plugged pores and reduce bacteria or oral antibiotics are available by prescription and may be used. Effective medical treatments for severe acne have been available for several years. These medications include tretinoin (Retin-A) topical products and isotretinoin (Accutane), an oral form of a vitamin A derivative. Accutane can cause severe side effects, and its use must be followed closely by your doctor.

Many medicines used to treat acne make your skin more sensitive to the sun. Although a sunburn may make blemishes less noticeable and dry the skin, too much sun exposure carries the increased risk for skin cancer.

Finally, don't squeeze or pick those pimples! This can lead to infection or scarring.

With proper self-care and advice from your doctor, you can conquer your angst about adult skin problems.