Red in the face? How to tell whether it's acne or rosacea

Acne can persist well into adulthood, particularly in women. And it can cause emotional distress and scarring regardless of age. But several steps can help. First, though, you need to determine whether the problem might be rosacea, a disorder often mistaken for acne.

TRIGGERS

Acne can be caused or aggravated by greasy products for hair or skin; the menstrual cycle, menopause, pregnancy, and stress; starting certain drugs, such as anticonvulsants and corticosteroids, or stopping birth control pills; and, rarely, an adrenal or ovarian tumor.

Rosacea occurs when tiny blood vessels in the face become dilated and inflamed, usually in fair-skinned people older than 30. Triggers include alcohol, exercise, extremes in temperature, and hot or spicy foods. Flushing is an early sign. In up to half of the cases, the eyes become red and begin to burn, itch, or tear. In advanced stages, the skin thickens and the nose may become bulbous.

TREATMENTS

Acne. Wash with warm water and mild soap, perhaps combined with an over-the-counter product with benzoyl peroxide or salicylic acid, for up to 12 weeks. If that doesn't help, or if the acne causes scars, see a dermatologist promptly, since it's much harder to treat scars than acne.

The doctor should usually start with a topical antibiotic either alone or combined with a topical retinoid, which helps unclog pores. If those don't work, oral antibiotics may be safer than the contraceptives occasionally used. Isotretinoin (formerly marketed as Accutane) should be reserved for extreme cases because it can lead to birth defects.

Rosacea. Flare-ups can be reduced by avoiding triggers. Two prescription antimicrobial drugs, metronidazole (MetroGel and generic) and azelaic acid (Finacea), can control eruptions. A lowdose oral antibiotic, which acts as an anti-inflammatory, can also help. Topical retinoids should be reserved for cases that don't respond to standard care.

This article first appeared in the June 2010 issue of Consumer Reports On Health. For more on healthy skin, see our reports on sunscreens and anti-wrinkle serums,  and our section on preventing and treating acne.