Acne Vulgaris vs Rosacea
Acne Vulgaris and Rosacea are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Acne Vulgaris vs Rosacea at a glance
- Acne Vulgaris: Chronic inflammatory disorder of the pilosebaceous unit driven by androgens, sebum, keratinization, and Cutibacterium acnes.
- Rosacea: Chronic centrofacial inflammatory dermatosis with flushing, persistent erythema, telangiectasias, papules/pustules, and ocular involvement.
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Side-by-side comparison
| Feature | Acne Vulgaris | Rosacea |
|---|---|---|
| At a glance | Chronic inflammatory disorder of the pilosebaceous unit driven by androgens, sebum, keratinization, and Cutibacterium acnes. | Chronic centrofacial inflammatory dermatosis with flushing, persistent erythema, telangiectasias, papules/pustules, and ocular involvement. |
| Classic presentation | Mixed comedonal and inflammatory lesions in seborrheic distribution (forehead, nose, cheeks, chin, upper chest and back).; Visible facial, chest, or back lesions; mild tenderness with inflammatory papules and nodules; Psychosocial distress, anxiety, depression — disproportionate to objective severity in many patients; Post-inflammatory… | Centrofacial distribution sparing periocular and perioral skin; absence of comedones distinguishes from acne.; Episodic flushing in response to triggers, lasting minutes; Persistent centrofacial erythema (cheeks, nose, chin, central forehead) — spares periocular skin; Burning, stinging, dryness, sensitivity to topicals; Ocular: foreign… |
| Workup / key labs | Clinical diagnosis based on lesion morphology and distribution. Severity graded as mild (comedonal ± few inflammatory papules), moderate (numerous papules/pustules ± few nodules), or severe (widespread nodulocystic disease, scarring, or failure of prior therapy).; Generally clinical diagnosis — no routine labs; If suspect… | ROSCO 2017 phenotype-based criteria. Diagnostic: persistent centrofacial erythema OR phymatous changes. Major: flushing, telangiectasia, papules/pustules, ocular findings (lid margin telangiectasia, conjunctival injection, keratitis).; Clinical diagnosis — no laboratory testing required; Consider ANA if photosensitive malar rash or… |
| Imaging | Not indicated for routine acne; Pelvic ultrasound if PCOS suspected | Not indicated |
| First-line treatment | Mild comedonal: topical retinoid — tretinoin 0.025-0.1%, adapalene 0.1-0.3%, tazarotene 0.05-0.1% (apply at night; avoid in pregnancy except adapalene category C; start every other night to limit irritation); Mild-moderate inflammatory: benzoyl peroxide 2.5-10% ± topical antibiotic — clindamycin 1%, erythromycin 2% (always combine… | General: trigger avoidance, daily broad-spectrum sunscreen SPF ≥30, gentle non-soap cleansers, fragrance-free moisturizer; Persistent erythema: topical alpha-agonists — brimonidine 0.33% gel daily or oxymetazoline 1% cream daily (rebound erythema possible); Telangiectasias: pulsed dye laser, KTP laser, or intense pulsed light (IPL);… |
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