Acne across the cheeks is hard to miss. But the most common form of acne on the cheeks actually is made worse by many of the things people do to control it.
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- Cheek acne can be caused by either common acne (acne vulgaris) or rosacea, or both.
- If you are a teenager, cheek acne is almost always caused by common acne, and the same treatments you use on the rest of your face will work on your cheeks.
- If you are over 25, cheek acne is usually caused by rosacea, and the treatments that worked for common acne when you were a teenager may actually make rosacea worse.
- Certain foods and supplements can trigger rosacea.
- Azelaic acid can treat both common acne and rosacea on the cheeks, but be sure to use exacty as directed.
Rosacea as a Cause of Cheek Acne
One of the most common causes of cheek acne is a condition known as rosacea. Although the textbooks may refer to this skin problem as “acne rosacea,” it is really little like the kind of acne that causes whiteheads and blackheads as well as pimples elsewhere on your face.
Common acne results from clogged pores. Rosacea results from broken blood vessels just beneath the skin. In people who have rosacea, the collagen lining capillaries that provide blood to the skin is prone to breakage. When these tiny blood vessels burst, they cause a dot of red color that can be seen through the skin. Sometimes as they heal, these blood vessels can accumulate scar tissue that can lend a lumpy texture to the skin, especially on the nose.
Rosacea differs from common acne in that it comes on much faster, often in just minutes. Cleansing pores won’t help rosacea because rosacea is not caused by clogged pores. In fact, anything that increases circulation the skin (and many treatments for everyday acne do) can increase pressure on the capillaries and trigger a rosacea attack.
How You Can Tell If Rosacea Is Causing Cheek Acne
Rosacea usually does not cause pimples in teens. Teens who will mature into adults who have rosacea are usually those who turn red with embarrassment or excitement or interest. Facial flushing predicts rosacea, but the full range of symptoms usually does not set in until after the age of 25.
After the age of 25, rosacea may cause increasingly visible signs of acne. The facial flushes that come with emotion may start leaving redness across the cheeks. Some of the inflammation across the cheeks may start coalescing into tiny red spots. These spots form where blood vessels burst. Purple streaks may form where blood vessels have been bruised.
Eventually it is possible to recognize triggers for outbreaks. The body cools itself by sending blood to the surface of the skin. When someone who has rosacea drinks a hot drink, blood flows into the capillaries of the cheeks and nose to exchange heat with the skin so the skin can drain heat into the surrounding atmosphere. If the linings of the blood vessels are weak, they make leak. This is a very common trigger for rosacea.
But there are many other circumstances in which circulation to the cheeks and nose increases and rosacea flares. Some people break out with rosacea when they eat foods that contain natural serotonin. Black walnuts and butternuts, which you can only find in the wild in North America, can trigger an immediate reaction. But there is also serotonin in:
- Tomatoes (2 micrograms/gram)
- Plums (4 micrograms/grams)
- Plantains (30 micrograms/gram)
- Pineapple (18 micrograms/gram)
- Pecans (29 micrograms/gram)
- Kiwi fruit (5 micrograms/gram)
- English walnuts (87 micrograms/gram)
- Bananas (15 micrograms/gram)
One way to find out whether these foods are the culprit behind rosacea outbreaks is to stop eating them and see if your skin gets better. But if you have a skin reaction to these foods, you are also likely to have at least mild stomach upset from these foods.
Another common but overlooked trigger for cheek acne is taking iron pills. The body uses iron to make hemoglobin, the oxygen-carrying molecule that makes blood red. Excess iron in the bloodstream can also cause free radical reactions that increase inflammation in the skin (and everywhere else in the body).
Nose spray can trigger rosacea across the cheeks. The steroids in prescription nose spray reduce inflammation in the sinuses, allowing trapped blood to circulate suddenly to the cheeks.
Steroid treatments for ordinary acne can trigger rosacea. Rubbing prednisone cream or getting a steroid injection into a pimple takes the redness out of the pimple, but also weakens and thins the skin. Thinner skin shows rosacea more easily.
And acne across the cheeks can be triggered by coming into a warm room from cold outdoors, exposure to the wind, drinking alcoholic beverages, eating spicy food, heat from the sun, heat from acne treatments, menthol in skin treatments, rubbing alcohol applied to skin, isopropyl alcohol in acne treatments, and almost every kind of herb and botanical that is added to “natural” acne care products.
Treating rosacea becomes in large degree a matter of what you don’t do. But there is also a treatment that works for both rosacea and any other form of acne on the cheek.
Azelaic Acid for Cheek Acid
Azelaic acid is often recommended for rosacea. It is also often recommended for the kind of common acid that causes whiteheads, blackheads, and pimples on the cheeks.
Plants make azelaic acid when they are infected by bacteria. In the plant, azelaic acid becomes a platform for the accumulation of salicylic acid, the same chemical that is used to make aspirin, to prevent destruction of tissues by bacteria.
In rosacea, azelaic acid reduces redness and inflammation. In common acne, azelaic acid stops acne bacteria. If you have either kind of acne or both on your cheeks, azelaic acid can be very useful for stopping outbreaks of pimples. If you have Asian skin tones, it will help reduce the formation of brown spots where there has been inflammation in your skin.
There is one important cautionary note for the use of azelaic acid. If you are a woman, use it on your cheeks and nose only. Azelaic acid has also been known to stimulate the growth of hair on the neck and chin. Do not use azelaic acid if you are already using topical tretinoin, Retin-A, or Renova.
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