Dr Schröder: Acne and rosacea 101

What are acne and rosacea? Our chemist Jaana battled acne in her teenage years, while our founder Kristina has dealt with both, so we jumped at the chance to get the 101 on these common skin diseases affecting girls, boys, women and men of various ages. Here, MD and dermatology specialist Marika Schröder guides us through the what and why of acne and rosacea.

What are acne and rosacea? Our chemist Jaana battled acne in her teenage years, while our founder Kristina has dealt with both, so we jumped at the chance to get the 101 on these common skin diseases affecting girls, boys, women and men of various ages. Here, MD and dermatology specialist Marika Schröder guides us through the what and why of acne and rosacea. 

Laponie (L): What are acne and rosacea from a dermatological point of view?

Marika Schröder (MS): Acne is an inflammation in the skin’s hair follicles and adjacent sebaceous (oil) glands. It causes pimples and sometimes larger boils in the face and on other areas of the skin with large amounts of oil glands, such as the chest and back. Acne is a common and chronic disease, with a 60-80% occurrence. It affects both men and women equally. It is most common during puberty but can also affect adults (i.e. adult acne). Severe acne may leave scars.

Acne is divided into different subtypes, which may occur simultaneously: comedogenic acne, regular acne, cystic acne and other forms of severe cystic acne.

Rosacea is more common among women but a lot of men suffer from it as well. It affects only the face, and typically occurs at 30 to 50 years of age. A sudden blotchy facial flush is a typical first symptom of rosacea, which also causes redness, swelling and over time might lead to permanently dilated blood vessels. A rosacea flush usually occurs longer than physiological blushing. Rosacea is not curable, but treatment usually improves symptoms.

Rosacea is divided into four subtypes, and patients may have more than one.

L: How do acne and rosacea differ from each other?

MS: Both may cause red spots, but whiteheads and blackheads are seen only in acne. For rosacea, redness, visible capillaries and flushing is more typical, and no larger boils usually occur.

It’s important to remember that many skin conditions, including rosacea but also e.g. perioral dermatitis, folliculitis and seborrhea may mimic acne. For proper treatment, it is vital to consult a dermatologist.

L: How are acne and rosacea diagnosed?

MS: Both acne and rosacea are diagnosed based on the patient’s medical history and clinical picture.

For acne, the symptoms are red and white pimples and blackheads on the face, chest, back and neck.

For rosacea, the symptoms might be only red pimples as in acne. Visible capillaries on the cheeks and/or nose are common but not mandatory, and sometimes also on the forehead. Redness may come and go, often in the form of flushing on cheeks, forehead and nose. Sometimes patients experience strong subjective symptoms such as tightness in the skin as well as a burning sensation.

L: What are the root causes of acne and rosacea?

MS: Both acne and rosacea are internal diseases, with a multitude of underlying causes. Both diseases are often genetic, and a large number of cases might be found in the patient’s immediate family.

For acne, root causes are age, genetics, hormones and external factors such as medication, illness and to some extent food.

For rosacea, the root cause is unknown, butas said,there may be a genetic component. Hot drinks, alcohol, strong spices, sunlight and sauna may all aggravate flush symptoms. Cortisone ointments for treating e.g. eczema and psoriasis may trigger rosacea-like symptoms on the face. For rosacea, maintenance treatment can prevent exacerbation.

L: What are the most common treatments for acne and rosacea?

MS: For both acne and rosacea, treatment is chosen according to the patient’s subtype and severity of the disease.

For milder forms of acne, topical treatment with over the counter or prescription products containing e.g. azelaic acid, benzoyl peroxide, salicylic acid, antibiotics and retinoids often used. In the case of more severe forms, oral antibiotics, isotretinoin and contraceptive pills are prescribed. With acne, the effects of treatment are typically slow, and the patient should be motivated to follow long-term treatment. It’s important to acknowledge that acne may cause cosmetic concern and also affect self-esteem. Especially regarding scarring and acne, it is important to start isotretinoin as soon as possible, to minimise the risk of permanent facial scars that are really difficult and expensive to treat later on.

For rosacea, the same oral treatments apply as for acne, though topical treatments differ.  Here, topical ivermectin, azelaic acid creams and brimonidine have shown results.

L: What type of skincare products should acne and rosacea patients use?

MS: As a general guideline, products which don’t clog pores or irritate skin. For rosacea, it’s also especially important to use sunscreen.

Marika Schröder (MD, PhD) is a Finnish specialist in dermatology with years of experience diagnosing and treating skin cancer and skin diseases, working both surgically and with laser. Dr Schröder is interested in aesthetic skin procedures and has in-depth knowledge of new treatment forms for acne and rosacea. She heads the Skin and Aesthetics Division at Pihlajalinna Hospital in the area of Helsinki. Pihlajalinna is one of Finland’s leading providers of social and healthcare services.

Dr Schröder is available for video and telephone appointments during corona restrictions; acne and rosacea are treatable at a distance and do not require face to face consultation. You can book online here