6 skin conditions that look like acne but aren’t

You might not have acne after all

not acne

How many times have you woken up, looked in the mirror and thought, “What invaded my face overnight?”

In a desperate attempt to erase any signs of the annoying red spots, you immediately reach for the fast-acting acne treatment and start rubbing away, only to be disappointed when that strange-looking pimple or rash is still staring back at you the next day.

There are many skin conditions that mimic acne, but are actually something else. A good indicator that the skin condition you are dealing with is not just acne is if the areas of irritation are still present after several acne treatments.

If you’re wondering what that stubborn rash or cluster of pimples is, read on to find out some of the more common skin conditions that resemble acne.

1. Psoriasis

Psoriasis is a chronic inflammatory disease of the immune system that starts under the skin. It’s characterized by skin cells that multiply up to 10 times faster than normal. As underlying cells reach the skin’s surface and die, their sheer volume causes raised red patches of skin covered with white scales.

It mostly affects the skin and joints, but it also may affect the fingernails, the toenails, the soft tissues of the genitals and the inside of the mouth. The most common variety of this condition is plaque psoriasis, and it produces lesions on the scalp, knees, elbows and lower back that can be itchy and painful after they bleed and crack.

Treatments listed below may be used alone or in combination with other treatments.

  • Topical Treatments with and without steroids usually are the first choice in treating psoriasis. Prescription topicals slow down skin cell growth and reduce inflammation.
  • Phototherapy involves exposing the skin to ultraviolet light on a regular basis and under medical supervision. Treatments are done in a health care provider’s office or at home with a phototherapy unit.
  • Systemic medications are prescription drugs that work throughout the body. They are used for individuals with psoriatic arthritis and those with moderate to severe psoriasis whose symptoms are unresponsive to other treatments. Systemic medications are taken orally, by injection or infusion and fall into two categories—traditional systemics and biologics.

Keep in mind—no single psoriasis treatment works for everyone. Working closely with a dermatologist is key to bringing psoriasis into remission.

2. Rosacea

This is the most common and well-known of all skin conditions misdiagnosed as acne. Rosacea causes small red or pus-filled bumps to develop on the skin and leaves the face with the appearance of a chronic flush and persistent redness across the cheeks, nose, forehead and chin. Those suffering from rosacea also describe a burning sensation associated with the bumps and redness and swelling in the eyes and eyelids.

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To treat rosacea, a dermatologist first finds all of the patient’s signs and symptoms of rosacea. This is crucial because different signs and symptoms need
different treatment.

Treatment for the skin includes:

  • Medicine that is applied to the rosacea.
    Sunscreen (wearing it every day can help prevent flare-ups).
    An emollient to help repair the skin.
    Lasers and other light treatments.
    Antibiotics (applied to the skin and pills).

Dermatologists can remove the thickening skin that appears on the nose and other parts of the face with:

  • Lasers.
    Dermabrasion (procedure that removes skin).
    Electrocautery (procedure that sends electric current into the skin to treat it).

When rosacea affects the eyes, a dermatologist may give you instructions for washing the eyelids several times a day and a prescription for eye medicine.

3. Allergic reaction

Skin allergies to external irritants can also cause spots, but are not actually acne. Allergic reactions to things such as foods, medications and skin products can produce a pimple-like rash that can easily be confused for acne. The most telling sign that what you are experiencing is not acne, but rather allergies, is severe itching that usually accompanies red scaly patches.

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If a patient is unsure what product is causing the rash, a dermatologist may conduct patch testing to try to identify the source of the allergy. Patch testing involves exposing the skin to chemicals that commonly cause allergies to see if one of them causes a reaction on the skin.

Once the allergen is identified, the appropriate treatment can be determined. For a mild reaction, patients might find an over-the-counter hydrocortisone 1% cream or ointment is helpful. A dermatologist may prescribe a topical steroid for more serious cases, though treatment with a topical steroid is dependent on the area of the face being treated, since steroid use can result in harmful side effects.

Patients should expect to see an improvement two weeks after avoiding the allergen. In some cases, it could take up to eight weeks before the symptoms clear completely.

4. Ingrown hairs

Ingrown hairs are hairs that have curled around and grown back into your skin instead of rising up from it. They are easily mistaken for common acne because they form like a pimple and can have pus inside of them, but unlike acne, they are itchy and tend to go away without any treatment (unless it becomes infected).

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Often, an ingrown hair will go away on its own. If it doesn’t go away, an ingrown hair can become infected, darken the skin, or leave behind a scar, especially if you’ve been scratching or picking at it.

If an ingrown hair is bothering you or has become infected, your doctor can make a small cut in your skin with a sterile needle or scalpel to release it. Doctor may also prescribe medicine such as:

  • Steroid medicine that you rub on your skin to bring down the swelling and irritation
    Retinoids (Retin A) to remove dead skin cells and reduce the skin pigment changes that can occur from ingrown hairs
    Antibiotic that you take by mouth or rub onto your skin to treat an ingrown hair infection

There isn’t any real treatment for ingrown hair other than to grow out your beard. Longer hairs aren’t as sharp at the ends, so they won’t be as likely to curl around and break through the skin. But for men who prefer a clean shave — or women — avoiding the razor may not be an option.

5. Folliculitis

When ingrown hairs become infected or inflamed, the condition turns into folliculitis, which may be caused by bacteria, yeast or other types of fungus. Folliculitis usually looks like red pimples with a hair in the center of each one. The pimples may have pus in them, and they may itch or burn. When the pimples break open, they may drain pus, blood or both.

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Call your doctor if you have folliculitis and:

  • It spreads or keeps coming back.
    You have a fever over 101°F (38°C).
    The affected area becomes red, swollen, warm, or more painful.

If the inflammation doesn’t go away or keeps coming back, laser hair removal may be an option. Laser treatment destroys the hair follicles, so they can’t get inflamed.

6. Basal cell carcinoma

Basal cell carcinomas are abnormal, uncontrolled growths or lesions that arise in the skin’s basal cells, which line the deepest layer of the epidermis (the outermost layer of the skin). It often looks like open sores, red patches, pink growths, shiny bumps or scars and are usually caused by sun exposure.

Taking a wait-and-see approach with this type of bump or sore is not a good idea. If you have a big pimple that has not responded to OTC treatments and refuses to go away, it is best to see your physician as soon as possible.

Fortunately, there are several effective methods for eliminating BCC. Choice of treatment is based on the type, size, location, and depth of penetration of the tumor, the patient’s age and general health, and the likely outcome to his or her appearance.

Treatment can almost always be performed on an outpatient basis in the physician’s office or at a clinic. With the various surgical techniques, a local anesthetic is commonly used. Pain or discomfort during the procedure is minimal, and pain afterwards is rare.

You might not have acne after all.


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