Acne or Rosacea: How Quality Images Help with the Difficult Task of Determining Which is Which

Written by Diana Ordonez

Acne is a well-known adversary for teenagers, but more and more adults are now enduring the challenges of acne-related skin conditions. According to the American Academy of Dermatology (AAD), adults continue to get acne well into their 30s, 40s, and even 50s, and it is even possible to get acne for the first time as an adult. Adult-onset acne is most common among women going through menopause.
However, what if the issue is not acne at all? For adults who believe they are dealing with raised red bumps and pimples, commonly known as papulopustular acne, the issue may actually be rosacea. According to the AAD, more than 14 million people are living with rosacea, and most people who get rosacea are between 30 and 50 years of age.


Although there is no connection between acne and rosacea, rosacea sufferers with bumps and pimples may mistakenly self-diagnose themselves as having acne. The two disorders require different treatment, however, and acne medications may cause rosacea symptoms to get worse.


Although discerning adult acne from papulopustular rosacea is nearly impossible with the naked eye, quality skin images can assist with the differentiation of these two skin conditions. These images combined with the identification of blackheads and whiteheads can help to identify the condition and its proper treatment for more efficient, longer-lasting results.


An acne eruption, composed of comedones – papules often found on the forehead and chincysts – hard pimples, and pustules results from bacterial activity and can be affected by a variety of factors, including puberty, hormonal fluctuations, diet, pharmaceuticals, stress, and more.


Rosacea, on the other hand, is a skin disease that typically appears in people during their 30s and 40s. Marked by redness of the face, a patient with rosacea may have one symptom or a combination of symptoms, including persistently red nose and cheeks, and bumps and pimples that look like acne. There are four types of rosacea, but it is papulopustular rosacea, with its redness, swelling, and papules and pustules, that is nearly indistinguishable from adult acne.



Although adult acne and papulopustular rosacea are almost identical in appearance, specialized lighting can produce images to help with a more accurate assessment. Cross-polarized lighting, certain specialized imaging devices that produce red images, and ultraviolet (UV) flashes all produce different images that expose various aspects of skin information to help to identify the correct skin condition.


Cross-polarized lighting eliminates the glare and shine off the surface of the skin to reveal subsurface melanin and redness. By processing this image using a specialized imaging device, the melanin-absorption elements are separated from the hemoglobin-absorption elements, enabling professionals to see inflammation across all skin types.


However, as lesions are present with both adult acne and papulopustular rosacea, a red image captured with a specialized imaging device by itself is not enough to differentiate acne from rosacea. To better differentiate the two, the type and location of the redness can help. As most rosacea patients have some level of overall facial redness, specialized image devices can help to differentiate between the more global redness associated with rosacea and the redness present only around lesions associated with acne. With red imaging technology, positive effects of treatment over time will show through the decrease in overall redness, even before it becomes apparent on the surface of the skin.


UV illuminated images – the most useful type of special image for differentiating adult acne from rosacea – capture the fluorescence of bacteria. Red fluorescence, which may be visible for both rosacea and acne patients, results primarily from the production of sebum, or the oily substance produced by the sebaceous glands. However, a yellowish-orange fluorescence is indicative of acne bacteria inside the pores and is seen only in the images of acne patients. This fluorescence, along with the presence of the pustules and papules and their localized redness, points to an acne condition. The lack of this yellowish-orange fluorescence, coupled with a more global facial redness, is more likely rosacea. Therefore, using specialized, red images along with UV illuminated images can confirm or deny the presence of redness and bacteria, and help to determine the true skin issue.


Proper assessment of skin conditions for clients is important for their well-being. Some conditions do not have an obvious diagnosis, but specialized photography can help identify the subtleties of many afflictions.


1 The red image (captured by a specialized imaging device, RBX processing technology) for an acne patient highlights the inflammation and redness present primarily around popular/postular lesions associated with acne.


In rosacea patients, the RBX red image also highlights vascularity and global facial redness.

3 The UV image of an acne patient depicts a lot of fluorescence (seen as yellow-orange).

4 The UV image of a rosacea subject will not generate any fluorescence (no comedones). Therefore, a rosacea subject’s fluorescence image will appear darker than the acne patient’s image.


Note: images enhanced for visualization.


Diana Ordonez is director of product management at Canfield Scientific, where she is responsible for consultative imaging tools, mobile applications, and cloud services, including the highly successful VISIA Complexion Analysis system, as well as strategic partnerships. Ordonez is a frequent speaker at industry conferences about using facial imaging systems to improve conversions, increase revenues, and market the capabilities of a medical spa practice. She is a member of the trade group Cosmetic Executive Women (CEW) and happy to be a contributor to DERMASCOPE. Ordonez holds a master of arts in industrial and organizational psychology from Montclair State University.

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