Rosacea vs. Adult Acne: A Case Report from Katy & Houston, Texas
Facial redness and breakouts in adulthood are not always acne. Many women in their 40s and 50s develop rosacea, a chronic inflammatory skin condition that can closely resemble acne. At Reena Jogi, MD, we frequently evaluate patients in Katy and Houston, Texas whose “acne” may actually be rosacea or perioral dermatitis.
This case highlights the importance of proper diagnosis and personalized treatment.
Patient Background
A 49-year-old female presented for follow-up after being seen in October 2025 for acne vulgaris and started on spironolactone 50 mg twice daily.
At her return visit, she reported persistent facial flares characterized by:
Flushing
Red bumps
Pustules on both cheeks
Given the distribution and clinical appearance, her current flare appeared more consistent with rosacea versus perioral/periorificial dermatitis, rather than traditional hormonal acne.
Examination Findings
Focused facial examination revealed:
Erythematous papules and pustules
Bilateral inferior central malar cheek involvement
Background redness and flushing
She was otherwise well-appearing, alert, and in no acute distress.
Understanding Rosacea in Adult Women
Rosacea is a chronic inflammatory condition that often affects adults over 30 and is frequently mistaken for acne. Unlike acne, rosacea commonly presents with:
Persistent facial redness
Flushing episodes
Visible blood vessels (telangiectasias)
Acne-like bumps without blackheads
Common rosacea triggers include:
Alcohol
Spicy foods
Stress
Exercise
Heat
Sun exposure
Wind
Proper diagnosis is essential because treatment differs from traditional acne therapy.
Treatment Plan: Combination Topical Therapy + Oral Antibiotics
After extensive discussion of risks and benefits, the patient elected to proceed with:
Triple Cream (Compounded)
Azelaic Acid 15% / Metronidazole 1% / Ivermectin 1%
This combination helps:
Reduce inflammation
Calm redness
Treat pustules
Address possible Demodex involvement
Doxycycline 100 mg Twice Daily (1 Month)
Doxycycline helps reduce inflammation associated with rosacea. Counseling included discussion of:
Photosensitivity (increased sunburn risk)
Taking medication with food and a full glass of water
Avoiding lying down for 30 minutes after dosing
Avoiding pregnancy during therapy
Because the patient was leaving for international travel in two days, she planned to initiate therapy upon return.
Follow-up was scheduled in 6 weeks for reassessment.
Skincare & Lifestyle Recommendations
Patients with rosacea benefit from:
Gentle cleansers (CeraVe, Cetaphil, Vanicream, La Roche-Posay, Neutrogena)
Moisturizers (green-tinted products may help camouflage redness)
Avoiding known triggers
We also discussed procedural options for persistent redness and telangiectasias, including:
Laser therapy
Rosacea Treatment in Katy & Houston, Texas
Facial redness and breakouts in adulthood require expert evaluation. At Reena Jogi, MD, we provide personalized treatment plans for:
Rosacea
Adult female acne
Perioral dermatitis
Hormonal breakouts
If you are experiencing flushing, redness, or acne-like bumps that are not improving, schedule a dermatology consultation in Katy or Houston, Texas for a customized treatment approach.
