How to Deal With Papulopustular Rosacea (2025)

Papulopustular rosacea is a chronic inflammatory skin condition that can be mistaken for acne. It’s one of four types of rosacea—a skin condition that may cause redness and flushing on the face. People with papulopustular rosacea also have pimple-like white heads.

The medical community is not sure what the exact cause of rosacea is, and there are no rosacea treatments that can cure the condition. However, avoiding rosacea triggers (like alcohol and some foods), using a gentle skin routine, applying topical treatment, and taking oral antibiotics can all help treat rosacea symptoms.

What Papulopustular Rosacea Looks Like

All types of rosacea cause red or flushed skin, usually on the cheeks or nose. This redness can come and go, but over time, it tends to stay for longer periods.In darker skin tones, it can appear as darker patches of skin or a dusky brown discoloration. It may also cause yellowish-brown bumps around the mouth or eyes.

People with papulopustular rosacea have pimple-like whiteheads that can appear with or without the redness and flushing typically associated with rosacea. This rash is often confused for acne papules, or zits, because that’s exactly what they look like.

These most commonly appear on the:

• Cheeks
• Chest
• Forehead
• Neck
• Scalp
• Skin

In addition to these papules, papulopustular rosacea can cause red bumps on the skin, most often on the face.

How Is Type 2 Rosacea Different From Acne?

Papulopustular rosacea, sometimes called type 2 rosacea, is easily confused with acne. Both cause pustules on the face, but there are subtle differences in how the conditions present, and how they need to be treated.

Even healthcare providers can have trouble distinguishing between acne and rosacea, so you should talk with a dermatologist if you suspect you have either condition. These factors can help determine which you have:

• How long it lasts: Acne is generally chronic and relatively stable; papulopustular rosacea can come and go, depending on triggers.
• Location of rash: Acne is widespread, whereas papulopustular rosacea is concentrated in the central face, especially the inner cheeks and nose.
• Presence of blackheads: People with acne often have blackheads in addition to whiteheads; those with rosacea do not.
  

Flare-Ups and Common Triggers

People with papulopustular rosacea often experience periods of more severe rash, followed by periods of clearer skin. However, the flares can also be long-lasting.

Rosacea usually flares up in response to triggers. Triggers vary between individuals, but the most common are:

• Alcohol
• Dairy
• Emotional stress
• Exercise
• Exposure to the sun and/or ultraviolet light
• Hot weather
• Medications (including steroids, niacin, and beta blockers)
  
• Spicy foods
• Skincare products
• Warm beverages
  
• Wind

About 1 in 4 people with rosacea say they have a trigger that’s not on this list, however, so it’s important to be aware of the individual pattern of your rash.

Seeing a Dermatologist for a Diagnosis

Rosacea should be diagnosed by a dermatologist, a doctor who focuses on the skin. Before your appointment, take pictures of skin changes and note any triggers you believe may be contributing to your rosacea. At the appointment the dermatologist will talk about your health history, perform a physical exam, and check your eyes, which can sometimes be impacted by rosacea.

Treatment Options

Prescription Medications

Four prescription antibiotics can be used topically to treat papulopustular rosacea. These are:

• Azelaic acid
• Dapsone
• Ivermectin
• Metronidazole

These are usually used for three to four months at a time. They are combined with oral antibiotics, including:

• Clarithromycin
• Clindamycin
• Doxycycline
  
• Erythromycin
  
• Minocycline

Oral medications may be given for four weeks to clear up an outbreak. Your healthcare provider might recommend staying on them longer-term as a preventive measure.

Nonprescription Medications

Since papulopustular rosacea often requires prescription treatment, it’s best to ask your healthcare provider before using any over-the-counter (OTC) creams. However, some OTC topical creams (applied to the skin) can help with mild rosacea. These include:

• Retinol
  
• Sodium sulfacetamide
• Sulfur
  

Home Remedies

Avoiding stress and triggers can help prevent rosacea flare-ups.Having a gentle skin routine and wearing sunscreen daily is also an important part of treating rosacea.

Dietary Management

Some people find that what they eat or drink triggers flare-ups. These dietary changes may help manage rosacea:

• Avoid hot or spicy food or drinks.
• Minimize caffeine.
• Avoid alcohol.
• Avoid peppers with the natural chemical capsaicin, which is associated with spiciness.
• Avoid foods with the natural chemical cinnamaldehyde found in cinnamon, chocolate, and tomatoes.
• Eat plenty of fiber.
• Eat probiotic foods like kefir or sauerkraut.

Basic Skin Care Routine

Establishing a gentle skincare routine is part of rosacea self-care. If you have rosacea, you should:

• Use gentle cleansing products, avoiding anything harsh or scented.
• Moisturize using a gentle, scent-free product.
• Wear sun protection daily, as sun exposure is a significant trigger for rosacea.

How to Stay Ahead of Flares

Avoiding triggers is the best way to stay ahead of rosacea flares. The two most common triggers for rosacea are sun exposure and stress. Wearing sunscreen every day will go a long way toward reducing your symptoms. Any steps you can take to reduce stress—like creating a mindfulness routine—will also help.

Summary

Papulopustular rosacea is a chronic skin condition that is often confused with acne. Whereas acne is widespread over the whole face, papulopustular rosacea is most common in the central area of the inner cheeks and nose. Papulopustular rosacea is treated with a combination of oral and topical antibiotics.

Creating a gentle skin care routine, identifying and avoiding triggers, and working with your dermatologist can help you mitigate the impact of papulopustular rosacea on your life.