Conditions That May Simulate Acne Vulgaris

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Rosacea

Papulopustular rosacea may resemble acne, but usually occurs on a backdrop of flushing and telangectasia. Comedones and cysts are absent except in rare cases when both diseases occur simultaneously. Most rosacea lesions are on the face.

Perioral Dermatitis

This localized eruption is almost exclusively limited to female patients. It presents with a localized papular and eczematous eruption with tiny pinpoint pustules in the perioral, perinasal, or periocular areas of the face. It superficially resembles acne, but lacks comedones, nodules, and cysts. Topical acne medications will exacerbate the condition.

Acne-Like Drug Eruptions

A long list of medications can cause an acne-like eruption. Hormones (especially systemic steroids), halogen-containing medications, tuberculostatic agents, and anti-epileptic drugs are the major classes of drugs. These eruptions consist of sheets of fragile pustules, which are not limited to sebaceous locations. Comedones, nodules, and cysts are absent.

Gram-Negative Folliculitis

This is a complication of long-term antimicrobial therapy for acne. A patient who had achieved good control suddenly deteriorates. Multiple painful follicular pustules with or without nodulocystic lesions suddenly appear. Culture reveals Gram-negative pathogens. Appropriate antibiotics or isotretinoin are the treatment.

Pseudofolliculitis Barbae

Ingrown hairs of the chin and lateral neck areas are common in many young males, especially those of African-American background. These lesions are painful and respond only partially to acne medications. Observation of trapped hairs, looped hairs, and characteristic distribution establish the diagnosis. Shaving instructions are indicated.

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