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Differential Diagnosis: What may look like acne

While acne is by far the most common skin problem that people visit their dermatologist about, it is certainly not the only condition. Many skin problems resemble acne very closely, but are not actually acne, and they need to be identified properly and treated accordingly. While only a certified dermatologist should be making a diagnosis, it is up to the patient to initially suspect that their regular acne treatment may not be working, and to visit the dermatologist. Below are some of the common skin problems that may resemble acne.


Rosacea is a chronic skin problem that causes acne-like pimples to form on the cheeks, nose, chin, and the forehead. This condition generally does not develop before the mid thirties, but can be mistaken for adult acne. Rosacea, unlike acne, is a slowly progressive disease that should be treated and maintained to slow down progression. Here are some features that are distinct to Rosacea:

  • Rosacea generally begins at around age 35-40
  • Rosacea tends to affect women more often, but men more severely
  • Rosacea is most common in people of Northern European descent with pale skin
  • Flushing and blushing that is persistent is a hallmark feature of Rosacea
  • Broken blood vessels may become prominent as disease advances
  • Rosacea can also involve the eyes in the form of redness and itching

If you suspect that you may have Rosacea, visit a dermatologist as soon as possible. While Rosacea is not a life-threatening illness, it can be very annoying, and it is often progressive. The faster it is treated, the easier it is to keep under control.


Folliculitis occurs when the hair follicles become irritated and inflammation starts. While shaving is the most common cause of folliculitis, any source of irritation can cause it. They can mildly resemble acne. Here are some features that are distinct to folliculitis:

  • Can often result in infection from fungus, bacteria, and sometimes virus
  • Unlike acne, folliculitis can occur anywhere on the body
  • This problem is particularly common in African American men around the beard area

Folliculitis is a common problem for men, as shaving can often cause this in those who are prone. People with curly hair seem to be especially vulnerable as hair tends to get stuck. Fortunately, for most common cases of folliculitis, antiseptics that are available over the counter should be sufficient. If the infection becomes serious, visit a dermatologist for proper treatment.

Keratosis Pilaris

Keratosis Pilaris is a very common skin condition that is very often confused for acne. In keratosis pilaris, the skin produces small red bumps that appear to be like small zits on the arms, and less often the thighs and buttocks. It is a result of excess keratin on the skin, becoming trapped in the hair follicles.

  • Unlike acne, occurs on the arms and not the face
  • Keratosis pilaris has a sandpapery feel to it
  • Common in adolescence
  • Slightly more common in women
  • Not sensitive or painful

Keratosis pilaris is very common, but unlike acne, does not cause scarring or worsen. It is also not known to itch or be otherwise irritating, and does not have any other health consequences. It is not a serious condition, and will often resolve without any treatment.

Perioral Dermatitis

Perioral dermatitis is a common facial rash that occurs in clusters around the mouth area, upper lips, and the chin. These rashes can often be confused with acne pimples, but they are a caused by a separate condition.

  • This condition is much more prevalent in women
  • Unlike acne, blackheads and whiteheads will not be found
  • Steroid creams will aggravate this condition
  • Cosmetic products can sometimes aggravate the rashes

Perioral dermatitis mainly affects women from the age of 20 to 40. Generally, the symptoms are mild, but steroid creams should be avoided as they will aggravate the condition. If you suspect that you may have perioral dermatitis, visit a dermatologist for proper treatment.

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