Differential Diagnosis of Facial Papules

Rosacea, Acne, Seborrheic Dermatitis, Demodicosis: What to look for first in a red face

Name: Rosacea, acne, seborrheic dermatitis, and demodicosis: what to look for first in a red face
Published: 2026-08-23

Do not focus only on the cheeks; check the sides of the nose, eyebrows, scalp, eyelids, and comedones Check together whether it is present or absent.

Last modified August 23, 2026Doctor of Korean Medicine Yeon-seung Choi

Click on unfamiliar terms to see their meanings immediately.

persistent redness in the center of the face Erythema, comedones, and sebum-prone areas Keratin, and rough follicular skin texture may overlap. Rather than attributing everything to a single diagnosis, closely examine surface clues and expand the observation area to include the scalp and eyelids.

Points to check in the photos first

Even if they look similar, the dead skin, blisters, and borders may differ

We have provided both typical appearances and examples that look slightly different. Do not decide based on a single similar photo; compare how long symptoms like dead skin, wheals, comedones, or oozing have persisted in the same area.

Educational close-up example of facial skin showing visible fine blood vessels over persistent redness centered on the cheeks and sides of the nose, without comedones — **Fine superficial blood vessels visible over persistent erythema**
Redness in the center of the face and fine blood vessels that remain even when not triggered are different clues from temporary flushing. We check for rosacea along with papules, scaling, and eye symptoms.

Educational close-up example of rosacea showing multiple red papules and small pustules without comedones over persistent erythema on the cheeks and beside the nose — **Papules and small pustules on a red base without comedones**
The papules and pustules of rosacea resemble acne, but the absence of comedones is a key clue. Actual differentiation is based on the distribution of lesions and their progress.

Educational close-up example of acne showing small closed comedones and open comedones centered on adult cheek skin — **Acne-like lesions centered on comedones**
Comedones are important clues for distinguishing acne from rosacea or seborrheic dermatitis. Do not just compare red pimples; check if clogged pores are also visible.

Educational close-up example of seborrheic dermatitis showing redness and thin, yellowish scales at the boundary of the scalp and forehead — **Redness and yellowish scales at the scalp boundary**
Seborrheic dermatitis is characterized by thin, greasy scales in areas with high sebum production, such as the scalp, eyebrows, and sides of the nose. We compare the surface with scalp psoriasis, which forms thick plaques.

Points to check	Rosacea	Acne	Seborrheic Dermatitis	Demodicosis
Core Appearance	Persistent erythema, fine blood vessels, papules without comedones	Blackheads, whiteheads, and various types of inflammation	Redness in sebum-prone areas with oily or fine scales	Rough follicular skin texture, fine scales, uniform papules
Primary Location	Center of cheeks, nose, forehead, and chin	Face, chest, back	Scalp, eyebrows, sides of the nose, and ears	Sides of the nose, cheeks, forehead; eyelids possible
Sensation	Burning or stinging sensation	Tenderness, varies by lesion	Itching, dandruff	Itching, burning sensation, sand-like roughness
Differential clues	Flushing after heat, alcohol, or UV exposure	Risk of comedones and scarring	Scaling on the scalp or sebum-rich areas	Not diagnosed by detection alone

The presence of comedones strongly suggests acne

Papules related to rosacea and demodicosis can look like acne, but blackheads and whiteheads are key indicators of acne. Please provide both side-lit and close-up photos so that comedones are not obscured.

Check the location of scaling and extend the observation to the eyelids

Greasy scales on the eyebrows, sides of the nose, and scalp are clues for seborrheic dermatitis; however, cylindrical scales at the base of the eyelashes and eye irritation require an eyelid evaluation, including other types of blepharitis.

Educational close-up example of demodicosis showing rough follicular skin texture, fine scaling, and light redness on the cheeks and beside the nose — **Rough follicular skin texture and fine scales on the sides of the nose**
Demodex mites can exist on normal skin. A diagnosis is not made based on rough skin texture alone; it is determined by comparing the distribution and test results with rosacea, seborrheic dermatitis, and acne.

The presence of Demodex mites is not always the cause

Demodex mites can be present on the skin of healthy adults. Rather than relying on a single numerical value or magnified photo, a medical examination is used to determine if they align with current papules, scaling, and itching, or if rosacea, seborrheic dermatitis, or acne provide a more appropriate explanation.

Do not only magnify the cheeks; please examine the face, scalp, and eyelids together

Please take separate photos of the entire face, scaling on the sides of the nose and eyebrows, blackheads/whiteheads, and the eyelid margins. Also, please provide the names of any ointments and cosmetics you have used.

Educational close-up example showing fine scales around the eyelash roots, redness at the eyelid margins, and mild congestion — **Cylindrical scales at the eyelash roots and eyelid irritation**
Scales at the eyelash roots can be seen in Demodex-related blepharitis, but they also resemble other types of blepharitis. Eye pain, light sensitivity, or changes in vision require an ophthalmological evaluation first.

Observe comedones, fine blood vessels, scaling in sebum-rich areas, follicular roughness, and eyelid scales side by side.

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Content to follow

Could facial redness, burning sensations, and small papules be rosacea?
How is it distinguished from acne, seborrheic dermatitis, and contact dermatitis?
Why is herbal medicine treatment important for recurring rosacea symptoms after using ointments?

Medical Evaluation GuideWhat should I record when symptoms improve after applying ointment but then reappear?Rather than simply noting that symptoms have reappeared, please record which area became itchy again and after how many days, the name and frequency of the ointment used, and any new changes such as oozing, pain, or a feeling of heat. It is important to consult with your prescribing medical provider before suddenly stopping or changing a prescribed ointment on your own.Medical Evaluation GuideWhen your skin changes after using new cosmetics, shampoo, or detergentsRather than attributing the cause to a single new cosmetic product, please record the affected areas, the date you started using it, whether the product was rinsed off or left on the skin, and any substances you come into contact with through your occupation or hobbies. Sensitive areas such as the eye area and face can also be affected indirectly through substances on your hands or in the air.

You can check the simple meaning first before proceeding to the detailed explanation

Skin terms used in this differential guide

TelangiectasiaTelangiectasia refers to a change where fine red lines are persistently visible on the cheeks, nose, etc. It may appear alongside temporary flushing, but it does not mean the same thing.PapuleA papule refers to a small, raised skin lesion. Unlike pustules containing pus or vesicles containing clear fluid, papules often feel firm beneath the surface.Skin heat sensationSkin heat sensation is the feeling that the skin is "burning or flushing." We distinguish between actual fever, inflammatory heat, flushing, and neurogenic sensations.ErythemaErythema is a term used to describe the state of the skin becoming red; it is not the name of a single disease. It is necessary to observe whether the redness fades when pressed and if it is accompanied by heat, pain, or scaling.Concurrent CareConcurrent care for skin diseases is a process of determining the necessary sequence of treatment by transparently sharing dermatology diagnoses, topical medications, and tests with Korean medicine care.

When herbal medicine treatment is the primary focus

We set the goals for herbal medicine treatment based on your previous treatments and when symptoms recurred

Redness and papules on the face and scalp can recur not only due to external exposure and local inflammation, but also in conjunction with heat sensations, stress, and sleep patterns. Based on differential diagnosis and previous treatments, Korean herbal medicine treatment focusing on managing the conditions that cause recurrence may be central.

Before the consultation

We ask where it appeared and when it worsened again

We examine the duration of the flushing, the presence of capillaries, papules, pustules, and scales, as well as eye symptoms and reactions related to digestion, sleep, and tension.

During treatment

We check if not only the itching, but also sleep and daily life are improving

We check how long the redness lasts, the number of new papules, the burning sensation, and the burden felt during face-to-face activities.

Treatment sequence

We set the goals for herbal medicine treatment by identifying the problems that need to be resolved first

If there are causes that require immediate priority, such as infection or rapid worsening, those treatments come first. Subsequently, for herbal medicine treatment, we determine the primary goal of recovery by examining current discomfort, recurring patterns, sleep, digestion, and fatigue, and coordinate the sequence with necessary dermatological treatments.

While reducing aggravating factors through lifestyle management, herbal medicine treatment determines the initial target by analyzing the pattern of lesions, sleep, digestion, and fatigue through pattern identification (Byeonjeung). Necessary skin treatments are continued in accordance with the progress.

Consult about treatment

Evidence and Update Information

This content was organized by Korean medicine doctor Choi Yeon-seung and updated on 2026-08-23.

American Academy of Dermatology, Acne or rosacea?
American Academy of Dermatology, Facial redness
AAD, Rosacea signs and symptomsFlushing, persistent color change, blood vessels, papules, skin thickening, and eye symptoms