All about rosacea and acne rosacea

Rosacea is a chronic skin condition that most notably causes flushing and redness on the face. Just like acne, it’s a highly misunderstood condition and it’s often misdiagnosed. True rosacea is actually very rare and in the decade or so that I have been practicing, I have probably had over a hundred people who thought they had rosacea because they were diagnosed or they self-diagnosed and only 3 of those people actually had rosacea. Symptoms of rosacea might flare up then calm down in cycles but rosacea flare ups tend to last weeks or months whereas acne flare ups tend to last years.  

ROSACEA IS OFTEN MISDIAGNOSED FOR THESE CONDITIONS

• Acne rosacea is often confused for a type of acne called inflamed acne

• Irritation from using skincare products that are too strong, irritating, or not appropriate for your skin type

• Irritation from using skincare products that are not nourishing or moisturizing enough 

• Redness from chronic picking or post-inflammatory hyperpigmentation (PIH) which are dark marks leftover from inflamed acne or picking

• Redness from having a genetic tendency to flush easily that is common in people with fair skin

SYMPTOMS

There are four subtypes of rosacea that I list below but there are some common symptoms that can occur with all of the subtypes:

• Redness and flushing on the face or body that looks like a sunburn

• Broken blood vessels on your face or eyes that look like spider veins

• Rough, raised, dry patches called plaques

• Sensitivity, burning, stinging

• Oils skin or enlarged pores

• Bumpy skin texture

ROSACEA TYPES

You might have one or a combination of these subtypes and your type of rosacea might also shift throughout your life:

• Subtype One: Erythematotelangiectatic Rosacea

  This is the most well known form of rosacea characterized by persistent redness, flushing, and enlarged blood vessels.

• Subtype Two: Papulopustular Rosacea
  This is rosacea that occurs with acne-like breakouts.  It can also show up as hardened patches called plaques and excessive oiliness.

• Subtype Three: Phymatous/Rhinophyma Rosacea
  This is a rare type of rosacea that causes thickening skin on the cheeks, chin, forehead, ears, or nose (Rhinophyma).

• Subtype Four: Ocular Rosacea
  This type of rosacea affects the eyes and can cause symptoms like pain, swelling, redness, and vision issues.

CAUSES

The cause of rosacea is unknown but, much like acne, it’s likely a multifactorial disease that is caused by the perfect storm of genes, internal factors, and external factors.  There are theories that it might be caused by a bacteria called Helicobacter Pylori, an overgrowth of demodex mites, or a protein called cathelicidin that might cause redness and swelling.  Similar to acne, there are many potential internal and external triggers that can initiate a flare up or exacerbate an existing flare up.  Everyone has different triggers so you might be triggered by one or a combination of any of these:

• Spicy foods

• Hot drinks

• Exercise

• Cosmetics and skincare products

• Certain drugs + medications

• Extreme weather (cold or hot)

• Sun exposure

• Wind exposure

• Stress

• Heat, humidity

• Alcohol

• Smoking

• Improper skincare routine (products that are too strong or not nourishing enough)

RISK FACTORS

Rosacea can affect anyone but these factors make it more likely:

• Fair skinned people with blond hair, blue eyes, and European descent

• Women are more like to develop rosacea than men

• Rosacea usually affects people between the ages of 30-50

• Family history of rosacea

• Smoking can increase the risk

DIAGNOSIS

There are no tests to diagnose rosacea but your Doctor will examine your skin and ask you questions to determine whether or not you have rosacea.  They might also test you to rule out lupus or allergies which both have similar symptoms. As I mentioned, many of our clients who have red, sensitive skin or a type of acne called inflamed acne come to us mistakenly thinking they have rosacea or acne rosacea because they have been wrongly diagnosed by a doctor or they have self diagnosed.  This isn’t a surprise since Doctors and Dermatologists tend to spend very little time actually touching and getting to know our skin, lifestyle, habits, and skincare routines. Most of the time, we find that they don’t actually have rosacea and their skin is just raw and red from not having a proper skincare routine or they have one of the four types of inflamed acne which are also characterized by redness, swelling, and soreness.

TREATMENT

Just like acne, there is no cure for rosacea and it’s a condition that needs to be managed long term using a multi-targeted approach.  Also, just like with acne, Dermatologists can be less than helpful and will likely spend 2 minutes barely looking at your skin before writing you one prescription after another.  In my experience, Dermatologists and Doctors rarely take the time to really understand our particular manifestation of a condition and to put the time into developing a comprehensive treatment plan that is customized based on our unique skin type, rosacea type, and lifestyle factors.  They will likely prescribe you a bunch of different topical and/or oral medications and they will just keep on prescribing until you land on one where the improvements you see outweigh the potential side effects. Some common treatments might include:

• Antibiotics like doxycycline, tetracycline, or minocycline may reduce swelling, inflammation, and the acne like bumps that occur with Papulopustular Rosacea.

• Isotretinoin is a very strong drug that may be prescribed under one of it’s brand names like Accutane, Absorica, Myorisan, Sotret, Zenatane, Amnesteem, or Claravis.  Potential side effects include vision and hearing problems, birth defects, liver or pancreas problems, increased pressure inside the skull, and joint pain.

• Topical treatments like Brimonidine 

THE AES SOLUTION

Many of our clients with acne rosacea (subtype 2: Papulopustular Rosacea) have seen significant improvements with our prescription-free program using a combination of personalized product plans made up of balancing and nourishing skincare products and lifestyle coaching.  Since most people who come to our clinic thinking they have rosacea actually just have irritated skin, inflamed acne,or PIH, we take a 3-step approach to determining whether or not they actually have rosacea:

1. The first step whether we are working with a client who has rosacea or acne is to rehabilitate any sensitivity and dryness using our skincare products made up of balancing, nourishing ingredients.  This helps rule out sensitivity and irritation. If a client is local and able to come to our clinic, we will customize a product plan for them during the Initial Consultation but we also teach our long distance clients how to customize their own product plan based on where there skin is at on any given day through our Virtual Program and our e-course The 8 Steps To Clear Skin. 

2. Once someone is on an appropriate product plan, the second step is to clear their acne with our prescription-free program which helps rule out regular acne vs. rosacea acne. 

3. Once the acne is cleared, we target the PIH using specialized chemical peels and products which rules out the possibility that the “rosacea” is actually pigmentation.

If there is still remaining redness or other rosacea symptoms after all of these steps, then it can be deduced that rosacea is actually present.   If you are curious to learn more, you can get in touch with any questions through our website or Instagram @aes_acneclinic.

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Fungal acne does not exist but here is how to treat Malassezia Folliculitis

Fungal acne is the new buzz term in the beauty world and everyone and their Moms think they have fungal acne right now.  But fungal acne doesn’t even exist! Literally, it’s not a thing y’all. So if you jumped on the fungal acne bandwagon and are now convinced that your acne is caused by fungus, read on.

ACNE CANNOT BE CAUSED BY FUNGUS

Just the very term ‘fungal acne’ is a contradiction in terms because acne is defined as a chronic condition caused by a genetic dysfunction called Retention Hyperkeratosis (RH).  RH is a disease that causes an overproduction of skin cells to get backed up in the follicle which then creates little acne “seeds” called microcomedones. These seeds then grow like a flower due to a number of internal and external factors like diet, products, and bacteria called triggers.  If the seed becomes big enough to rupture the follicle wall, inflammation sets in but inflammation is just a symptom of acne, not the cause of it. So acne is a formation of lesions formed primarily by dead skin cells, not fungus.  

WHAT EXACTLY IS ‘FUNGAL ACNE’ THEN?

What is inaccurately referred to as ‘fungal acne’ is actually a condition called pityrosporum folliculitis or malassezia folliculitis (MF).  MF and acne both occur in the hair follicles but unlike acne which is caused primarily by an overgrowth of dead skin cells, malassezia folliculitis is caused by an overgrowth of yeast called malassezia.  We actually all have yeast and bacteria all over our skin and inside of our bodies and they serve important functions but MF develops when this particular fungus (yes, it is a fungus) proliferates for a number of potential reasons.  Antibiotic usage can kill all of the “good bacteria” in our bodies and cause a yeast imbalance. And similar to acne mechanica, prolonged heat and moisture caused by occlusive clothing like tight, sweaty exercise clothes can also cause yeast overgrowth. 

WHY DO THEY CALL IT FUNGAL ACNE IF IT’S NOT ACTUALLY ACNE?

Two words: ignorance and confusion.  Even the most highly paid beauty bloggers and influencers are so freakin’ ignorant about acne that they just refer to any type of bumps on the skin as acne. It’s also easy to confuse the two because there are 7 different types of acne and one type of acne, non-inflamed acne, looks similar to MF because they both look like small bumps under the skin.  This is a tricky type of acne that most people don’t identify as acne because it’s not big or red. A lot of people don’t even refer to it as acne, they refer to it as “texture” and I have even had some clients who have been mistakenly told by their Dermatologist that it’s an allergic reaction! If the skin doctors have trouble discerning the different types of bumps on our skin then it’s no wonder there is so much garbage information out there.

HOW DO I KNOW IF IT’S FUNGUS OR ACNE?

A fungal infection like MF can look so similar to non-inflamed acne that it can be hard to tell the difference.  The only way to know for sure if you have MF is to have it checked and examined under a microscope by a Doctor but here are some hints:

1. Does it itch? 

   Acne does not typically itch and MF does.  The only time you will have itchy acne is if you have an inflamed acne lesion but that kind of itching is typically mild and doesn’t last a long time.  And if it is inflamed acne, it will be swollen, red, and maybe full of pus so it will look very different from the small uniform bumps that characterize MF. 

2. Pattern

   MF bumps tend to appear in clusters and are uniform in size whereas acne tends to be randomly distributed and appears in varying sizes.

3. Is there a head or a core?

   All types of acne start with a little “seed” called a microcomedone that is made up of mostly dead skin cells so all of the 7 types of acne have a grain-like seed inside of or on the surface of the skin.

FOREHEAD BUMPS ARE USUALLY CAUSED BY THIS

Lots of bloggers and influencers who talk about fungal acne claim that it usually appears on the forehead.  But MF is actually more common on the body than it is on the face. It’s more likely that your forehead bumps are caused by Retention Hyperkeratosis and triggered by comedogenic hair products.  I say triggered because acne, regardless of what type or where it is located, is always caused by RH. If you are genetically prone to acne and are using a shampoo, conditioner, or hair styling product that contains one of these pore-clogging ingredients or you have recently gone to the hair stylist or gotten your hair blown out and they used a comedogenic product in your hair, you are likely breaking out from that. We have a whole Pinterest board with acne-friendly hair product recommendations that you can check out but make sure to double check the ingredients of every product (even if I suggested it!) before purchasing since products get reformulated all the time.

HOW IS FUNGAL ACNE TREATED?

Only your Doctor can diagnose and propose a treatment for your MF but it’s usually treated with one or a combination of these:

1. Lifestyle adjustments

   Avoiding saunas, sun exposure, and steaming
   Wearing loose fitting clothes
   Changing sweaty workout clothes right away
   Showering immediately after exercising

2. Anti-fungal shampoo or body wash

   You might be prescribed a shampoo that contains selenium sulfide, pyrithione zinc, or ketoconazole like Selsun Blue or Nizoral.

3. Oral anti-fungal medication

4. Prescription topical creams

HOW TO GET RID OF ACNE ONCE AND FOR ALL

Hopefully you have a better idea after reading this whether or not you actually have “fungal acne”. If you are one of the few who actually has MF, you should get in touch with your Physician so they can advise you on next steps. If you are just of the many people who have been mistakenly thinking that you have fungal acne but you actually just have stubborn acne, our acne programs offer a prescription free method for getting clear in a way that offers sustainable, long term results.

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