I Struggled With Acne For Years — But It Wasn't Acne At All

Design by Seung Won Chun.
"What's going on with your skin?" my mom asked (bluntly, but lovingly) during a FaceTime call. I didn't know how to answer. I was 23, and my skin was acting up in ways it never had before, not even when I had vicious breakouts as a teenager. As an adult, I'd gotten used to my skin being temperamental, with a hormonal blemish or two popping up on my jawline during my off-week of birth control. But this — the bumps, the redness, the clusters of pimples? I'd never seen myself like this before.
It only seemed to get worse as time went on. None of the products I tried were working. The worst of it came the spring after my 25th birthday, when the redness intensified and the patches of bumpy skin got, well, bumpier. I saw a dermatologist, who suggested the stress of starting a new job could be to blame and prescribed me a topical cream and medicated face wash. In the following weeks, the hormonal-specific breakouts that had been normal for me before did go away. But the redness and bumpiness on my cheeks not only didn't improve, but even started to spread over my nose. Something was wrong here.
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I started looking into everything from dietary changes to exercise, and even tried guided meditation and yoga to de-stress, because as the dozens of health-enthusiast Instagram pages I follow told me, environmental stressors could have everything to do with it. I even wondered if maybe I just needed more sleep (I didn't — I slept for 12 hours one night and saw no difference). The worst part might have been the uncertainty: Because the symptoms would come and go, with clear skin one day and a bumpy mess the next, I never knew how my skin would behave. It stressed me out and started to affect my self-esteem.
More than a year after the worst of it began, a close friend told me about her experience with rosacea, a common skin condition that causes redness, small bumps, or sometimes broken blood vessels. The symptoms sounded oddly familiar, so I went back to the same dermatologist I'd seen before. I told him that the flareups made me think it might not be acne after all. "This might actually be rosacea," he said as he examined my skin — before I had even mentioned it myself.
It was a misdiagnosis, one that happens surprisingly often. “It’s very common for people to confuse acne and rosacea,” says NYC-based dermatologist Doris Day, MD. “This is because acne occurs at a younger age so people are familiar with getting it, while rosacea is something that usually doesn’t start until your 30s or younger, and can certainly happen in your 40s, 50s, or older." The appearance can also be deceiving: "While they are different conditions, there are overlaps in what we see," Dr. Day adds. "Rosacea can have the pimples similar to what we see in acne.”
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Frustrated by the initial misdiagnosis, I went to another dermatologist for a second opinion a few days later. “Yep, this is most likely acne-rosacea,” she said as soon as she got a closer look at my face. Acne-rosacea, as I soon learned, is a papulopustular form of rosacea, which means it presents as pus-filled bumps that are easily confused with acne. Unlike acne, acne-rosacea is an inflammatory condition, and doesn't have the bacteria found in blemishes. It's also possible to have acne and rosacea at the same time, but the face needs to be treated properly, as acne-fighting formulas containing benzoyl peroxide, salicylic acid, or glycolic acid can be way too harsh.
Because there's no one known "cause" of rosacea, I had to educate myself on the common triggers. "We don’t know exactly what causes it, but popular triggers are stress, alcohol, extremes in temperature, and some spices,” says Dr. Day. But once it's been triggered, she says, you'll figure it out quickly — as in, within a day. In being more observant with my skin, I realized that heat, exercise, and dairy caused my skin to flare up. I also removed all the harsh peels and exfoliants from my bathroom cabinets and stocked up on oil cleansers, redness-reducing mists, and masks that work well for sensitive skin. As for blemishes, I use a spot treatment so that it’s only focused on the blemish and not irritating the rest of my face.
After a few short months, one 30-day cycle of an oral prescription, and a whole new skin-care routine, I've gotten back to having consistent good days as I learn how to manage my rosacea while also dealing with acne (whenever it comes, which is still more than I'd like). There's still some redness, but nothing I can't handle.
The biggest lesson I learned throughout the experience is to listen to your skin — consistent abnormality is not normal — and that sometimes a second professional opinion is necessary. That second opinion is what helped me find the right treatment so that I don't have to stress about the uncertainty... and now, when I FaceTime with my mom, she doesn't have to ask me what happened to my face.
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