Types of Rosacea: Papulopustular Rosacea

Chances are when you think of rosacea, you think of a singular chronic skin condition that causes red skin, often on the face. However, there are actually four distinct types of rosacea.

Papulopustular rosacea is a type of rosacea that causes acne-like symptoms. The most distinct symptom is pus-filled bumps that often appear on the forehead and cheeks. More accurately, these bumps are called papules and pustules. They develop deep within the skin, which makes them extremely resilient and difficult to get rid of.

Because papulopustular rosacea looks so much like acne, it’s important to know the symptoms and proper treatment method of papulopustular rosacea, also called subtype 2 rosacea. Mixing up acne and papulopustular rosacea can actually lead to worsening symptoms! Acne treatment won’t work on papulopustular rosacea and can even make it worse.

So, let’s uncover what exactly papulopustular rosacea looks like, how it compares to acne, and how to treat it.

What Are the Symptoms of Papulopustular Rosacea?

The symptoms of papulopustular rosacea are quite similar to what you’d think of as standard rosacea symptoms. Fun fact: when most people think of rosacea, they picture what’s called erythematotelangiectatic rosacea, or ETR.

Papulopustular rosacea can cause the same symptoms, like flushed skin, red bumps, a burning or stinging sensation, and visible blood vessels — but also includes the key pus-filled bumps.

These symptoms typically appear on the forehead, cheeks, chin, and nose.

What Causes Papulopustular Rosacea?

The exact cause of rosacea is still unknown. However, we do know some factors that can contribute to rosacea, including:

Genetics
Environment
Skin mites
Poor gut health
Inflammation
An imbalance of the skin microbiome

Interestingly enough, researchers believe that skin mites themselves don’t contribute to rosacea — but the bacteria that they carry do… That means an imbalance of bad bacteria to good bacteria in the skin microbiome likely accounts for more cases of rosacea than we even realize today.

What Triggers Papulopustular Rosacea?

Papulopustular rosacea triggers will vary from person to person, but there are some common trends doctors and researchers have observed among rosacea sufferers. Common papulopustular rosacea triggers include:

Emotional stress and anxiety
Spicy foods
Alcohol
Hot beverages
Extreme heat (weather, hot baths and showers, saunas, etc.)
Extreme cold
Strong winds
UV rays
Physical exertion
Foods high in histamines

According to the National Rosacea Society, even non-spicy foods like yogurt, liver, and sour cream can act as rosacea triggers.

What Are the Differences Between Papulopustular Rosacea and Acne?

Both papulopustular rosacea and acne are very similar-looking skin conditions. In fact, papulopustular rosacea is sometimes confusingly referred to as ‘acne rosacea’. However, these two conditions aren’t related. The use of the term acne rosacea can lead people to believe they’re simply suffering from acne along with their rosacea. However, acne and rosacea are two distinct conditions that need to be identified as such.

One of the key differences between papulopustular rosacea and acne are the treatment methods. Using acne treatment on papulopustular rosacea can actually make the condition worse. That’s why receiving a proper diagnosis should be your first priority when you discover these pesky bumps on your skin.

Another distinct difference between acne and rosacea are blackheads. Blackheads aren’t a symptom of subtype 2 rosacea. They’re only a symptom of acne. On the other hand, persistent redness is primarily a symptom of rosacea, but it can be present to some degree with acne. You can also experience redness if you’re using a harsh acne treatment that is drying out your skin.

Likewise, rosacea is often associated with dry skin, while acne is more likely to be associated with oily skin. However, like with redness, overly harsh acne treatments can dry out the skin. Before determining whether your skin is naturally oily or dry, consider the products in your skin care routine.

At the end of the day, to make the proper diagnosis between papulopustular rosacea and acne, you’ll need to visit the dermatologist. Both skin conditions can cause red, bumpy skin. The untrained eye won’t likely be able to distinguish between the two.

How Is Papulopustular Rosacea Treated?

Because there is no cure for rosacea (yet!), treatment focuses on managing symptoms and improving your overall quality of life. Here are several ways you can begin improving facial redness and eliminate pesky pustules:

Protecting Your Skin From the Sun

61% of rosacea sufferers rank sun exposure as their biggest rosacea trigger.

Sun exposure has such a big effect on rosacea because the UV rays cause the growth of new blood vessels, which increases facial redness and flushing severity. Not to mention a rise in body temperature from the sun and any physical exertion while outdoors can also increase your risk of a rosacea flare-up.

To help protect your skin from the powerful UV rays, stay in the shade when possible and avoid the harshest hours of sunlight during the day (between 10am and 2pm).

For the best protection, apply a rosacea-friendly sunscreen that has 30+ SPF. The best sunscreens for flushed, sensitive skin are made with zinc oxide and/or titanium dioxide and are free of chemicals like oxybenzone, avobenzone, octisalate, octocrylene, homosalate, octinoxate, and fragrances.

Identifying and Avoiding Triggers

To determine your personal rosacea triggers, work with your health care provider and keep a journal to note where you’ve been, what you’ve eaten, or what you’ve been exposed to when you experience a rosacea flare-up. This will help you better track trends and decipher what’s causing your redness and bumps to worsen.

When you’re first trying to identify your triggers, remember to be patient and kind to yourself. This can be a tough and long process, which is why it’s so much better to partner with your doctor to help you narrow down your personal rosacea triggers.

The best part is, once you’ve identified your personal triggers, avoiding them will likely significantly improve your rosacea symptoms.

Balancing Your Skin Microbiome

Research shows that the skin microbiomes of people with rosacea are very different from the skin microbiomes of those with healthy skin. An imbalanced skin microbiome affects your immune system, inflammation levels, natural protective barrier, and the overall well-being of your skin.

As new research continues to develop about the connection between bad bacteria in the skin microbiome and rosacea, it becomes increasingly evident that balancing your skin microbiome can have extremely positive outcomes on your rosacea.

To keep your skin microbiome healthy, you need to first restore balance — then you can enter a maintenance phase, where you continue to support and nourish your good bacteria and keep the bad bacteria in check.

You can help support the skin microbiome and regain balance in your skin microorganisms by:

Opting for gentle, preservative-free, skin care products
Using Gladskin Redness Relief Cream
Avoiding over-cleansing or over-exfoliating
Moisturizing with a preservative-free moisturizer
Supporting gut health

Choose Gentle Skin Care

A huge component of treating papulopustular rosacea and caring for your skin microbiome involves a gentle, preservative-free skin care routine. When suffering from papulopustular rosacea, it’s crucial to use gentle, hypoallergenic topical products. Harsh chemicals in skin care can worsen redness and increase skin irritation.

For that reason, avoid skin care products containing:

Drying alcohols
Camphor
Fragrance
Glycolic acid
Lactic acid
Menthol
Sodium laurel sulfate
Urea

Visiting Your Dermatologist

Hopefully you’ve visited your primary care provider or dermatologist for an accurate diagnosis of papulopustular rosacea. During that time, it would be ideal to also speak about your treatment options.

Everyone’s skin is unique, and your dermatologist can provide a personalized papulopustular rosacea treatment plan. Not every treatment option will suit your needs!

One of the primary forms of treatment prescribed by dermatologists is topical creams. Antibiotic and steroid creams are both potential options, and they both pose certain risks that are important to be aware of.

If you opt for a topical steroid, educate yourself on topical steroid withdrawal. TSW occurs when you stop the use of the steroid cream, and it can actually make your rosacea symptoms much worse than before you started.

Antibiotics, on the other hand, aren’t able to only target bad bacteria in the skin microbiome. That means that both good and bad bacteria get wiped out when using topical antibiotics. Killing off good bacteria can have greater long-term consequences and leave your skin at-risk.

Sometimes these treatment measures are necessary, but it’s always best to be informed before making a decision.

Your doctor may also opt to prescribe low-dose oral antibiotics.

If none of those options work or suit you, the next recommendation often includes laser or light therapy.

This therapy uses pulses of light to reduce the size of blood vessels in your face and lower inflammation, itchiness, and irritation. Laser therapy is often needed on a recurring basis to experience the full benefits.

At the end of the day, speak with your doctor and dermatologist about how best to treat your papulopustular rosacea. They’ll be able to see your skin and discern what’s best for you in the short- and long-term.

Gladskin’s Best Products for Papulopustular Rosacea

If you’re ready to start the journey to rebalancing your skin microbiome and relieving symptoms of rosacea, you’ve come to the right place.

We’ve created a trio of products to help support you and your rosacea.

Gladskin’s Redness Relief Trio combines three helpful products for rosacea sufferers. The kit includes:

Redness Relief Cream that restores balance to your skin's microbiome while moisturizing.
Gladskin Makeup Remover for Rosacea-Prone Skin protects the balance of your microbiome while effectively removing makeup.
Gladskin Facial Cleanser for Rosacea-Prone Skin respects and protects the beneficial bacteria in your skin microbiome while gently cleansing the skin.