It is important to realize that there are many facial eruptions that may mimic acne.
Rosacea, cosmetic acne, epidermal cysts, seborrheic dermatitis, allergic contact dermatitis, angiofibromas, solar elastosis, keratosis pilaris, perioral dermatitis and sycosis barbae are the main skin conditions affecting the face which resembles the acne.
Clinical features and presentations of each are different from acne. Am overview of these conditions will help in differentiating these from the pimples.
Rosacea as an Acne Mimic
Rosacea, misnamed acne rosacea, is the commonest acne mimic. Rosacea is characterized by red bumps in the central part of the face. It is a disease of middle age, unlike the teenage-predominant acne. Acne has a hormonal basis, while rosacea is caused by a variety of factors, including hypersensitivity reactions to mites, food, environmental factors, stress, and so on.
Blackheads and whiteheads, which are hallmarks of acne, are conspicuous by their absence in rosacea.
Acne Cosmetica Mimicking Acne
Oil or lanolin-based cosmetics can cause eruptions resembling acne in some individuals. These appear as itchy red bumps and rashes on the face and, at times, on the neck. These are due to an allergic response caused by contact irritant dermatitis or due to blocked pores. Comedones are absent and itching is a prominent symptom in acne cosmetic.
Using water based make up will prevent acne cosmetica eruptions in most individuals. While choosing face creams, look out for the non-comedogenic label.
Epidermal Cysts and Milia Resemble Acne
Small, white bumps containing a cheesy material appearing below the eyes and on the cheeks can resemble the white heads of acne.
Epidermal cysts and milia are usually harmless, and can be removed through needle excision and curettage.
Acne Like Bumps in Dandruff (or Seborrheic Dermatitis)
Both acne and moderate to severe dandruff and seborrheic dermatitis can coexist, the hormonal basis being the same. Scales in severe dandruff can block the pores and produce popular eruptions, especially on the forehead and scalp.
Infection caused by Pityrosporum ovale, the fungus involved in dandruff, can cause similar bumps. These are itchy and present as pus filled bumps related to the hair follicles.
Allergic Contact Dermatitis Causing Facial Eruptions
Allergy due to a variety of agents like cosmetics, chemicals, soaps, shampoos and dust can cause itchy red bumps and rashes resembling acne papules on the face.
Treatment of these types of allergy are different from that of acne and involves topical and/or systemic steroids, antihistamines, barrier creams, and, of course, avoidance of the allregen.
Favre- Racouchet Syndrome Presenting with Comedones
Prolonged sun damage to facial skin, especially around the eyes, produces changes in the dermal layer, known as solar elastosis, the well-known weather-beaten appearance. This is one condition where large, grouped blackheads appear on the face of individuals above the age of 50 years.
Sun protection, topical tretinoin, laser ablation and surgical excision are the treatment options available for solar elastosis. Sun protection with a sun protection factor of 50 or above should be worn at all times while outdoors.
Sycosis Barbae or Pseudofolliculitis Barbae with Facial Bumps
Curly hairs in the dark skinned can cause chronic irritation and firm bumpy eruption on the beard. These are caused by inflammation and secondary infection caused by hairs getting trapped as they regrow into the skin.
Daily shaving, or removal of the hair through laser will prevent this type of inflammation. Infection is treated by topical and systemic antibiotics.
Acne Mimic: Keratosis Pilaris
Small, brownish red bumps appearing on the arms, shoulders, thighs and buttocks of adolescents are thought to be due to selective deficiency of certain vitamins and essential fatty acids. The typical chicken skin appearance is the hallmark of this disease.
Treatment of keratosis pilaris is with topical tretinoin, alpha hydroxyl acids and vitamin supplements.
Facial Angiofibroma with Skin Colored Facial Bumps
These are skin colored round bumps, around one to two millimeters in size, usually around nose, cheeks and lower face. These are signs of underlying genetic diseases like tuberous sclerosis and usually similar eruptions are present in other family members. Other skin presentations of tuberous sclerosis like ashy leaf macules, cafe au lait patches and shagreen patches should also be sought for in such cases.
Treatment of facial angiofibroma is mostly surgical or with lasers.
Perioral Dermatitis: Itchy Facial Rash
Usually affecting older females, itchy red rashes around the lips and nose may resemble acneiform eruptions. These are usually caused by food allergy and exacerbated by topical steroids.
Avoidance of irritating hot, spicy food, doxycycline and topical benzoyl peroxide at lower concentrations will help rid perioral dermatitis
It is clear that all eruptions on the face are not acne and the treatment of each is different from that of acne. Proper diagnosis is thus important in differentiating and managing these acne mimics.
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Disclaimer
The information given in this article is for educational purposes only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or Suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
Hanish Babu - Dr.Hanish Babu, MD is a dermatologist and a feature writer on Suite101.com with more than 200 articles related to skin diseases on the ...
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