Do I have rosacea or KPRF or something else? (Photos)

Question

Do I have rosacea or KPRF or something else Hello! I’m 23(F) and I’ve been dealing with persistent redness and red bumps for about two years now. My skin type is normal to dry. As a teenager and young adult, I neglected my skin and have sustained notable sun damage (sun spots, early signs of aging). I want to do better and start taking care of my skin. I’ve done lots of research on what the redness and associated red bumps could be, but I’m not sure. Heat and stress are definitely a trigger for the flushing and I have visible broken capillaries on the top of my cheeks. The red bumps aren’t painful or not really itchy. I don’t have KP on other parts of my body either. My doctor is willing to prescribe me topical creams without really inspecting my skin or asking questions. I don’t have health coverage so I’d have to pay out of pocket. I just want a more conclusive ideas of what’s going on so that it can be treated properly the first time. I suspect either rosacea or KPRF. Both conditions are similar in terms of terms of appearance, but they’re treated differently. Any help is greatly appreciated. TYIA

Anna Chacon, MD, FAAD · Answer

Do I have rosacea or KPRF or something else? (Photos)
Answer by Anna Chacon

Thank you for explaining your history so clearly — that makes a big difference. I can hear how frustrating and confusing this has been, especially when you’re trying to be proactive and want to make sure you’re treating the right condition from the start. That’s a very reasonable goal.

From your description and what you’re noticing — persistent central facial redness, flushing triggered by heat and stress, visible broken capillaries on the cheeks, and red bumps that are not very itchy or painful — this pattern leans much more toward rosacea than keratosis pilaris rubra faceii (KPRF).

Here’s how I typically help patients distinguish the two:

Features that support rosacea:

Flushing triggered by heat, stress, spicy food, or temperature change

Persistent redness across the cheeks and central face

Visible broken capillaries (telangiectasias)

Acne-like red bumps without blackheads

Sensitive, reactive, often dry-feeling skin

Onset in young adulthood is common

Features more typical of KPRF:

Usually starts earlier in life

Often associated with keratosis pilaris on arms or thighs

More uniform rough follicular bumps

Less flushing trigger response

Fewer visible surface blood vessels

More texture-driven than flush-driven

The flushing triggers and visible capillaries you mentioned are especially characteristic of rosacea and are not classic for KPRF.

Sun damage can absolutely make rosacea appear worse and more persistent. UV exposure weakens superficial blood vessels and increases background redness over time. So your observation about past sun exposure is relevant and important — not as a cause, but as a contributor.

It’s also understandable to feel uneasy about being prescribed creams without a close look or discussion. While some overlap treatments exist, rosacea and KPRF are managed differently enough that a thoughtful diagnosis matters.

In general terms:

Common rosacea treatments include:

Anti-inflammatory topicals (like metronidazole, azelaic acid, ivermectin)

Barrier-repair moisturizers

Strict daily sunscreen use

Trigger avoidance strategies

Vascular laser for visible capillaries (when needed)

KPRF treatments focus more on:

Keratolytic moisturizers

Gentle exfoliation strategies

Texture smoothing rather than vascular control

One more reassuring point: at 23, even with some early sun damage, your skin still has strong recovery potential. With the right approach, redness and bumps can often be significantly improved and stabilized.

Do I have rosacea or KPRF or something else? (Photos)

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