Cheek acne vs rosacea: Here’s how to tell the difference

Cheek acne vs rosacea how to tell the difference

Discovering red bumps on your face might lead you to think it’s just another round of acne, but not so fast — rosacea could also be the culprit.

With their noticeable overlap in appearance, distinguishing between acne and rosacea can be quite challenging.

To shed light on this common confusion, we consulted Dr Lauren Thomas, a doctor at Software, who helped us identify the key differences between these skin conditions.

Clinical features of rosacea and acne

Though they may look the same at first glance, acne and rosacea actually show differently on the skin. For someone who isn’t used to diagnosing skin conditions, identifying these differences may be tricky.

“The main difference between acne and rosacea is that comedones are present in acne and not rosacea. This means that you will not see any blackheads or small skin-coloured pimples associated with rosacea,” said Dr Thomas. 

“Some other differences are that acne will typically cause larger pimples, including cysts and nodules, whereas rosacea often causes smaller papules and pustules. Rosacea also tends to be associated with flushing and redness of the skin because of numerous capillaries.”


The triggers and underlying causes of cheek rosacea vs acne are also different, so it can be a good idea to check for any patterns.

“Some may notice a direct worsening of their rosacea from alcohol, spicy foods, stress and sunlight shortly after exposure. Rosacea is often associated with sensitive skin, which results in flares from strong skincare products,” said Dr Thomas.

“These triggers don’t affect acne in the same way. There is some overlap in triggers for acne and rosacea, such as excessive sun exposure and stress. Acne can be made worse by sweat, humidity and comedogenic products such as heavy foundations, which can block pores,” she adds.

Dr Lauren Thomas

Dr Lauren Thomas.

Different types of rosacea

You’re probably aware that there are several types of acne, but did you know that rosacea can also be of different varieties?

“There are numerous types of rosacea, with papulopustular being one of the more common types – and the easiest to get confused with acne. This is because it can also cause whiteheads and small red bumps, similar to what some will get with acne,” said Dr Thomas.

“There are also other variants of rosacea such as erythematous telangiectatic (ETT) which cause only redness. There are then other localised types which, for example, may only affect the nose or eyes.”

Where does rosacea and acne occur?

The location of your flare-ups can be a hint as to what condition you’re dealing with:

“Rosacea typically affects only the face, whereas acne may occur on the back, shoulders and chest, as well as the face. Occasionally someone may get acne on their back but not on their face,” said Dr Thomas.

“Rosacea most often affects the cheeks, whereas acne tends to be more spread out. It can affect the cheeks, forehead and jawline.”

Who it may affect

“Acne is more typically linked with oily skin, whereas rosacea is more often associated with dry skin – however, both can occur. People with rosacea often have sensitive skin and their skin may react to more products including prescription and over-the-counter items,” said Dr Thomas.

Plus, rosacea is more common in females and typically occurs later in life, while acne is more common in men and tends to happen during the teenage years.

Treatment for rosacea and acne

Treatment methods for rosacea and acne can be very similar since both conditions can result in the appearance of red papules and pustules. For example, retinol is commonly used for both.

However, there are still subtle differences here, as Dr Thomas explains: “People with rosacea may find that prescription retinoids are too irritating for their skin. In this circumstance, topical retinol that is available over the counter may be a better fit. Or azelaic acid may be another good alternative for those with sensitive skin.

“Similarly, both conditions may have oral antibiotics, such as doxycycline, prescribed. These treatments are used because of their anti-inflammatory benefits; not because of their antibiotic effect. This means that instead of being used for one week like when used to treat an infection, they are often used for three or more months.”

Medical treatments aside, one of the best ways to combat acne, rosacea or any other skin disease, is to treat your skin kindly every day with the right products.

“Both acne and rosacea will benefit from a regular skincare routine consisting of a cleanser and moisturiser in the evening, and a cleanser and sunscreen in the morning, with the addition of moisturiser again in the morning, if required,” said Dr Thomas.

Just be sure to choose gentle products that will calm the skin down, and not trigger it further.