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Acné et rosacée : comment les distinguer ?

What Are the Differences Between Acne and Rosacea?

Acne and rosacea are two chronic inflammatory skin conditions that are often confused with each other. In fact, they can lead to the same physical manifestations, namely pimples and redness.

Summary
Published September 14, 2022, updated on March 4, 2024, by Sandrine, Scientific Editor — 7 min read
Acne
Rosacea

The Differences Between Acne and Rosacea

This point is essential, but not obvious! Because both acne and rosacea are accompanied by temporary, but also by permanent redness (erythema). In the case of rosacea, these rednesses are also accompanied by small, fine, red or purple blood vessels that are visible to the eye. In addition, rosacea may cause inflamed and sometimes painful pimples and/or pustules to appear on the surface of the skin, just as acne does. Nevertheless, there are some differences between these two skin conditions.

  • They appear in different areas

Rosacea mainly affects the face, while acne can be visible not only on the face but also on other parts of the body, such as the shoulders, torso and back.

  • Blackheads are unique to acne

Blackheads are small retention lesions that form when excess sebum (hyperseborrhea) and dead cells called keratinocytes (hyperkeratinization) accumulate and clog hair canals. This mixture, in contact with the air, oxidizes, creating a small, hard, black ball on the surface. On the face, blackheads are most visible in the T-zone, which corresponds to the nose, chin and forehead.

Blackheads are found only related with acne, making it possible to differentiate between acne and rosacea.

  • Characteristics associated only with rosacea

Hot flashes and eye involvement (ocular rosacea) are usually not present in acne. Note that ocular rosacea can sometimes precede skin disease. It manifests as conjunctivitis, eye irritation, inflammation of the eyelids (blepharitis), watery red eyes (conjunctival hyperemia), burning, dryness with an uncomfortable feeling in the eyes, and hypersensitivity to light (photophobia).

  • Affected skin types and phototypes

An important difference between acne and rosacea is that acne affects only combination to oily skin, whereas rosacea can affect all skin types. In addition, rosacea is more likely to occur in people with lighter skin.

Different Biological Mechanisms

Rosacea occurs due to a disorder of the skin's immune system, the excessive presence of skin mites (Demodex folliculorum and Demodex brevis) and certain bacteria. It can also be caused by an abnormal function of the blood vessels or by a malfunction of the meibomian glands located at the edge of the eyelids (ocular rosacea).

Acne, in turn, is characterized by, among other things, excessive secretion of sebum (hyperseborrhea). A buildup of dead cells called keratinocytes (hyperkeratinization) that clog hair ducts, and colonization of the skin by a bacterium called Cutibacterium acnesrather than a mite as in rosacea.

Aesthetic Consequences Are More Pronounced in Acne Than in Rosacea

Severe acne can unfortunately leave scars on the surface of the skin. We speak of scars when the mark is still visible a year after the lesion has healed. We distinguish two types of acne scars: atrophic scars, which have a deepened appearance, and hypertrophic scars, which are slightly blistered and have a kind of protrusion of the skin tissue. In addition, acne can also lead to pigmented (brown) spots. This post-inflammatory hyperpigmentation is due to excessive production of melanin, a pigment in the skin whose main function is to protect skin cells from UV rays. This type of sign is more common in mixed to dark phototypes.

Rosacea rarely leaves visible consequences. A single case of rosacea, called rhinophyma and occurring mainly in men, leaves signs characterized by thickening of the skin around the nose.

Azelaic Acid, an Important Active Ingredient in the Control of Acne and Rosacea

Azelaic acid occurs naturally in some cereals such as barley and is one of the dicarboxylic acids. It is contained in medicines for the treatment of acne and is applied topically in concentrations of between 15 and 20%. In cosmetics, creams and serums rarely contain more than 10%. However, even in this concentration, its action against skin impurities is significant.

In pharmaceuticals, this active ingredient was first formulated in an anti-acne cream in the early 1980s. Later, its possible effectiveness against rosacea was reported. For example, one study showed that the number of inflammatory lesions and erythema improved continuously after 15 weeks of treatment with a gel containing 15% azelaic acid.

To date, the mechanisms of azelaic acid against rosacea are largely unknown. Nevertheless, it is very likely that the anti-inflammatory properties of azelaic acid, which acts by neutralizing reactive oxygen species, also known as free radicals, are responsible for such effectiveness. In addition, azelaic acid has antimicrobial activity and can inhibit the production of inflammatory mediators by follicular bacteria, thereby relieving redness and irritation.

In addition, the side effects associated with azelaic acid gel 15% are usually mild or temporary and usually do not require discontinuation of treatment.

Thus, a cream with azelaic acid is a useful solution as a first measure if you want to effectively combat rosacea.

You can also find this compound in our mattifying serum.

Note: Acne and rosacea are skin diseases, so visiting your dermatologist is of utmost importance. Depending on the nature of your rosacea or the severity of your acne, the dermatologist will prescribe an appropriate treatment.

Sources

  • ELEWSKI B. E. Azelaic acid 15% for treatment of rosacea. Expert Opinion on Pharmacotherapy (2006).

  • LAYTON A. & al. Azelaic acid 15% gel in the treatment of rosacea Harald. Expert Opinion on Pharmacotherapy (2008).

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