Acne Vulgaris

[Guide]

image courtesy of Wikimedia Commons

Acne Vulgaris is a completely different disease from rosacea, however some authoritative sources report that acne vulgaris can co-exist with rosacea.[1] In past literature, 'acne rosacea' was the term used to describe adult acne, and, this term is sometimes still used. [2] However, rosacea is generally confined to the facial area while acne vulgaris can be not only on the facial area but also on the trunk (chest and back). Treatments for acne usually irritate or exacerbate rosacea and is one of the differentiating diagnostic marker for a rosacea diagnosis. [3]

According to the American Academy of Dermatology, acne is the term for plugged pores (blackheads and whiteheads), pimples, and even deeper lumps (cysts or nodules) that occur on the face, neck, chest, back, shoulders and even the upper arms. Acne affects most teenagers to some extent, but can also affect adults in the 20s, 30s and 40s. [4] Usually when pimples and pustules are present physicians treat acne vulgaris with acne (condition) treatments. [5] Acne is technically a condition while acne vulgaris is a disease.

When acne treatments exacerbate the condition usually this indicates Rosacea Phenotype 4, changing the diagnosis in the patient and switching the treatment to rosacea. [6] This naturally begs the question, what is the difference between acne and rosacea? [3] 

A proper diagnosis needs to be from a physician. [7]

"The infiltration of γδT cells was significantly increased in rosacea and acne lesions and positively linked with almost all hub genes. These identified hub genes and immune cells may play a crucial role in the development of rosacea and acne." [8]

End Notes

[1] "It should be noted, however, that it is possible for acne vulgaris and rosacea to appear at the same time in the same patient." Medscape

[2] “It is interesting that the original term for rosacea was “acne rosacea”, which has more features in common with acne than currently realized. If the “acne” portion had been retained in the later works, rosacea might have received much greater investigative attention.” A Personal Critique on the State of Knowledge of Rosacea Albert M. Kligman, M.D., Ph.D. Department of Dermatology, University of Pennsylvania, Philadelphia, PA, U.S.A.

[3] What is the difference between acne and rosacea?

Diagnosing Acne vs. Rosacea (Stanford Medicine 25)

[4] Rosacea 101: Includes the Rosacea Diet, page 2, Brady Barrows

[5] "If self-care remedies don't clear your acne, see your primary care doctor. He or she can prescribe stronger medications. If acne persists or is severe, you may want to seek medical treatment from a doctor who specializes in the skin (dermatologist)." Acne, Symptoms and Causes, Mayo Clinic

[6] "Your doctor may prescribe an oral antibiotic such as doxycycline (Oracea, others) for moderate to severe rosacea with bumps and pimples. If you have severe rosacea that doesn't respond to other therapies, your doctor may suggest isotretinoin (Amnesteem, Claravis, others). It's a powerful oral acne drug that also helps clear up acnelike lesions of rosacea. Don't use this drug during pregnancy as it can cause serious birth defects." Rosacea, Symptoms and Causes, Mayo Clinic

[7] Diagnosing Rosacea

[8] PubMed RSS Feed - -Exploring the association between rosacea and acne by integrated bioinformatics analysis

[Guide]

There are several acne treatments used to treat rosacea, i.e., Dapsone, Sarecycline, Azithromycin, Minocycline, and the list continues, not to mention the plethora of over the counter acne treatments to consider. A typical example of an acne treatment, Benzaclin, that is also used to treat rosacea is discussed in the following paper: 

“Based on the theory that rosacea shares the same inflammatory features of acne, a recent study showed that, just as the combination of benzoyl peroxide 1 percent and clindamycin 5 percent gel is a powerful treatment modality for reducing Propionibacterium acnes levels, it also significantly reduces the papules
and pustules of rosacea, according to Debra L. Breneman, M.D..… ‘Benzaclin, once daily, was found to be well tolerated and effective in the reduction of papules and pustules in patients with rosacea,’ said Dr. Breneman. ‘This lends credence to the theory that P. acnes is a potential aggravating factor in rosacea. This gives dermatologists a very effective treatment for rosacea.’ ” [1]

Herbal Extracts for Acne 

One report on the 'clinical efficacy of herbal extracts in treatment of mild to moderate acne vulgaris' concludes, "This herbal extracts can be a new therapeutic option for patients with mild to moderate acne vulgaris who are reluctant to use drugs." [2] 

The herbal extracts include:

Mangosteen extract
Lithospermum officinale extract
Tribulus terrestris L. extract
Houttuynia cordata Thunb extract

End Notes

[1] Dermatology Times Publish date: Apr 1, 2003
P. Acnes Possible Factor in Rosacea BenzaClin a significant Tx in lesion reduction
Beth Kapes

Another example similar to above paper discussing topical benzoyl peroxide 5%/clindamycin 1% (BP/C) gel (BenzaClin) concluded, "These results showed that BP/C was significantly more effective than vehicle in improving papules and pustules associated with rosacea.'

Cutis. 2004 Jun;73(6 Suppl):11-7.
Photographic review of results from a clinical study comparing benzoyl peroxide 5%/clindamycin 1% topical gel with vehicle in the treatment of rosacea.
Leyden JJ, Thiboutot D, Shalita A.

[2] J Dermatolog Treat. 2019 Oct 16:1-5. doi: 10.1080/09546634.2019.1657792. [Epub ahead of print]
Clinical efficacy of herbal extracts in treatment of mild to moderate acne vulgaris: an 8-week, double-blinded, randomized, controlled trial.
Yang JH, Hwang EJ, Moon J, Yoon JY, Kim JW, Choi S, Cho SI, Suh DH.