Rosacea Misdiagnoses

Patient Expert

I was diagnosed with rosacea, but my skin isn't responding to the rosacea treatments. In fact, it's getting worse. Is it possible that I have both rosacea and acne?

In a word, yes. For some patients, it is possible to have both rosacea and acne. Trying to treat both, however, can aggravate the situation because the two conditions require very different remedies. Most acne medications work by increasing cell turnover and exfoliation. Unfortunately, this can worsen rosacea since the skin is sensitive and often reacts poorly to harsh cosmetics. On the flip side, rosacea sufferers commonly report dry, flaky skin and thicker moisturizers can clog oily skin still further.

There is also the chance that you may not have rosacea. Although the National Rosacea Society estimates that 14 million Americans have the condition and remain unaware of it, other doctors claim that the skin disorder is over-diagnosed in patients. In 2004, Dr. Herbert P. Goodheart, a private practice dermatologist in New York City, wrote an article entitled "Is it Rosacea, or Just Rosy Cheeks?" in the journal Women's Health in Primary Care.

While rosacea treatment doesn't necessarily harm those with normal skin, Dr. Goodheart estimated that about 20 percent of new patients who claimed they had rosacea simply flushed easily due to their fair skin and Celtic ancestry. If you don't have any bothersome or clearly definable rosacea symptoms, it's not necessary to jump the gun and start treating rosacea before you're fully sure of the diagnosis.

Instead, Goodheart suggested that people observe the symptoms for up to two years to see if the symptoms become worse before using prescription creams and antibiotics. Some patients are reluctant to hold off on treatment, because they fear that rosacea will get more intense if left alone. The reality is that untreated rosacea does not necessarily get worse.

However, just because your symptoms don't intensify does not mean that you can rule out rosacea definitely. The National Rosacea Society warns that some patients get misdiagnosed with adult-onset acne and the subsequent treatment can make redness worse. In order to prevent misdiagnoses, the Society focused on specific criteria to judge whether or not a patient exhibits symptoms of rosacea and requires treatment and/or therapy.

The most common symptoms of rosacea occur in the center of the face. People experience flushing, persistent redness, small acne-like pimples and visible capillaries. Other symptoms can include irritated or bloodshot eyes, rough or thickened skin, burning or stinging, raised red patches, and swelling. If your symptoms are limited to flushing and redness, hold off on aggressive therapies. Keep a journal of when you experience the symptoms and also track what foods you ate at the time and whether or not you had any alcohol. Alcohol and spicy foods do not cause rosacea, but they can trigger some symptoms and may help your doctor diagnose you more accurately.

In the meantime, if you experience some of the more intense symptoms, such as severe eye irritation, consult your doctor immediately. Some rosacea patients suffer extreme eye irritation that can damage the eyes and cause blindness.