You survived adolescence, with its pitfalls and pinnacles. You're free of the trials and tribulations of your early 20s. But on the road of life, other hazards loom—rosacea and adult acne, which can plague even the most timeworn skin. And you thought you'd seen your last blemish.


Rosacea is a chronic skin condition that affects the blood vessels and sebaceous glands of the face. The sebaceous glands produce an oily substance called sebum. Rosacea causes redness, tiny bumps or pimples, and small blood vessels to appear on the cheeks and nose. Occasionally the eyelids may be affected, becoming red and swollen.

In more severe cases, the sebaceous glands enlarge, causing the nose to become bulbous and the cheeks to appear puffy. The lower part of the nose may develop thick bumps; these bumps may also appear on the cheeks. This is more common among men than women.

Rosacea can cause permanent damage to facial tissue. If the eyes are involved, the affected area usually is confined to the eyelids. Only rarely is the surface of the eyes affected. Symptoms of ocular rosacea (conjunctivitis) are burning and grittiness.

Rosacea affects about 13 million American adults, particularly fair-skinned people between ages 30 and 50. It is most common in people of Celtic origin. Women tend to develop rosacea more often than men, but the condition is often more severe in men. It can be confused with adult acne, but in rosacea there are no blackheads (comedones), and adult acne does not cause flushing.

Early signs of rosacea include a tendency to flush easily. The redness becomes more persistent, and eventually tiny blood vessels or pimples appear. If you notice symptoms, see your doctor. Once diagnosed, rosacea can be treated.

The exact cause of rosacea is unknown; however, there are certain things that cause the face to flush and that can make rosacea worse. These include:

  • Sunlight and temperature extremes

  • Stress, anger, or excitement

  • Hot drinks and hot foods, spicy foods, and alcohol

  • Irritating cosmetics and other facial products

  • Strenuous exercise

  • Certain medications

Avoiding these risk factors may help lessen symptoms. Your doctor also may recommend certain soaps, moisturizers, and sunscreen products to improve the condition.

Topical antibiotics such as metronidazole are often necessary to help clear symptoms of rosacea. Oral antibiotics such as tetracycline, doxycycline, metronidazole, or monocycline may be needed in some cases. Under some conditions, a medication called Accutane or a topical retinoid cream may be prescribed. Laser surgery may be used to reduce blood vessels and swelling. The most successful treatment will likely be a combination of medication and self-care. Remember, rosacea can get worse without treatment and will most likely come back if you stop treatment.

Adult Acne

About one in five adults between ages 25 and 44 has mild to moderate acne. Blemishes can form on your face, neck, chest, back, shoulders, and upper arms. In severe cases, acne may cause scarring.

Acne is a disease of the skin that involves the sebaceous glands and the hair follicles to which they are connected. The oil glands and hair follicles (together called pilosebaceous units) are most numerous on the face, upper back and chest, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). The sebum produced by the glands normally empties onto the skin surface through the follicles pore. Sometimes a plug of hair and sebum may form in the follicle. Bacteria normally found on the skin can grow in the plugged up follicle and cause inflammation. When the wall of the plugged follicle breaks down, sebum, shed skin cells, and bacteria spill into the nearby skin, leading to pimples or lesions, the NIAMS says.

Lesions can come in several varieties, according to the NIAMS:

  • Comedo. An enlarged and plugged hair follicle. A comedo may stay closed, beneath the skin, producing a white bump called a whitehead. Or a comedo may reach the skin surface and open up to make a blackhead. The black color is not because of dirt but results when fatty material is oxidized to a dark color.

  • Papules. These are inflamed lesions that look like small, tender pink bumps on the skin.

  • Pustules. These are another name for pimples. Pustules are papules topped by pus-filled lesions.

  • Nodules. These are large, painful solid lesions deep in the skin.

  • Cysts. These are deep, painful, pus-filled lesions.

Reference: Skin, Hair and Nails section on Better Medicine

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True or false? Topical medications should be used primarily during rosacea flare-ups.