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Home / Acne / What skin conditions are often confused with acne?

What skin conditions are often confused with acne?

So you’ve woken up to a mystery spot - but what exactly is it?

Will it grow into a cluster of pimples? Will it spread across your face, your back, your neck? With so many skin diseases that present as spots, lesions and blemishes, it’s a challenge to discern the difference between acne and other skin conditions.

Read on to discover disorders often confused for acne vulgaris and rosacea and some that are not but are still important to know.

Remember - if you ever notice an unexplained change to your skin’s colour, texture or feeling, no matter how insignificant, inform a GP or dermatologist.

So what is acne?

The condition occurs when hair follicles in your skin become blocked and inflamed by too much sebum. Sebum is a natural substance that keeps your skin healthy, too much, however, can cause oily skin and other symptoms. For example, an acne sufferer will experience blackheads, whiteheads and smaller cysts.

If a plugged follicle is open, it will become a blackhead. If it is closed, it will be a whitehead. If bacteria can enter these compromised follicles, it can cause a variety of other skin problems, such as pustules, nodules and papules.

At certain times in your life, an influx of hormones will cause an overproduction of sebum, such as puberty or when a woman is at certain stages of her menstrual cycle.

1 - Contact dermatitis

Dermatitis is an umbrella term used to describe skin irritation. There are many different forms of dermatitis, however, when it is used in conversation, people are most likely referring to a type of eczema called contact dermatitis.

Contact dermatitis is the result of an overactive immune system that responds to seemingly innocuous stimuli like soaps and detergents, creating inflammation in areas that an irritant contacts.

If you have dermatitis, you should expect skin dryness and irritation. It may also present in patches as a rash, with the colour varying from red to brown, depending on your skin colour.

The best way to guard against flare-ups is to identify what your triggers are and avoid them.,

Common triggers of dermatitis includes:

  • pet dander
  • pollen
  • soaps
  • stress
  • weather

2 - Keratosis pilaris

Sounds like a scary disease, right? Well, don’t worry, it’s not. Keratosis pilaris is actually a harmless condition that affects many of us.

If you have keratosis pilaris, you will find it on your upper arms, thighs and bum. It presents as tiny red and brown bumps on the surface of your skin. Rough to touch, keratosis pilaris is sometimes itchy but rarely painful. You may also know the condition as chicken skin.

Keratosis pilaris will normally go away with age, usually around age 30.

Just like acne and many other chronic skin conditions, there is no cure, though it may be beneficial to:

  • moisturise
  • dab your skin dry
  • use unperfumed soaps and lotions
  • have cool showers and baths

You may also find you have breakouts in cold weather.

You most likely do not need to see your doctor for keratosis pilaris. If you find your case is particularly bad and is impacting daily life, you should speak to your GP. You may be prescribed steroidal creams or offered laser treatment in extreme cases. Your doctor will also properly diagnose you - it is important to make sure it is not another more serious condition.

So, what is the cause?

Keratosis pilaris occurs when a substance called keratin builds up and blocks hair follicles. Keratin is a protein that has the healthy function of helping your body produce and protect skin, hair and nails.

Though the exact cause is unknown, evidence suggests that keratosis pilaris is genetic. It is not contagious.

3 - Folliculitis

Folliculitis is the infection of hair follicles. It can occur anywhere on the body with hair, from the head to the buttocks.

The condition generally presents with smaller spots, yellow, red or white in colour, which are filled with pus. As you can imagine, these are easily confused with acne.

The severity of your case will dictate what treatment is best. Mild to moderate cases may improve without the use of medication. However, you should keep the affected area clean and avoid shaving or waxing the area until completely healed.

More severe cases may require steroid and antibiotic treatment. A prescription will be for oral antibiotics, topical antibiotics and topical corticosteroids. If symptoms are interfering with daily life, you may also be prescribed antihistamines and painkillers for itching and pain.

Extreme cases of folliculitis may require more invasive procedures like laser therapy, though this is rare. You should speak to your GP or dermatologist for more information.

So, what is the cause?

The condition is the result of fungal or bacterial infection. The usual suspects include:

  • Staphylococcus aureus (staph.)
  • Pseudomonas aeruginosa
  • Tinea barbae

These infections are commonly caught via skin-to-skin contact. However, they can also be transmitted from contaminated clothing and towels. Other sources of infection include spas, baths and pools - anywhere that lots of people may rub skin against surfaces.

The best way to minimise the chance of developing folliculitis is to:

  • avoid the shared use of clothing
  • wash after heavy sweating
  • wash after sports where you contact others’ uncovered skin (e.g. wrestling, boxing, certain watersports)
  • cover any open cuts or grazes

4 - Rosacea

Rosacea is an incurable skin condition that mostly affects the face - though may also affect the eyes. The exact cause of rosacea is yet to be determined, however, evidence suggests it is a genetic disorder.

The main symptom is facial flushing, which will occur in varying degrees depending on the individual. The condition is more prevalent in women than men*, and usually in those with paler skin.

*However, for men that do get it, it is usually worse.

Other symptoms of the condition include:

  • visible blood vessels
  • facial swelling (lymphoedema)
  • sensitive skin
  • pain and stinging
  • eye irritation

5 - Skin cancer

Cancer is the result of cells growing uncontrollably. When cells mutate, they form masses, referred to as tumours. If a tumour has the potential to spread, it is dangerous and labelled as cancerous. If a tumour will not spread, it is less dangerous and called benign.

There are two major categories of skin cancers:

  • melanoma
  • non-melanoma skin cancer (this is further divided into basal cell carcinoma [BCC], squamous cell carcinoma [SCC] and rarer forms)

Melanoma

Melanoma develops in cells called melanocytes - their job is to produce melanin, which is what gives your skin its pigment. Your skin “tans” when they are exposed to ultraviolet radiation, either from the sun or a sunlamp. A tan is a sign of your melanocytes producing more melanin to protect your skin. However, this natural “sunscreening” process is not always sufficient.

People with darker skin have more active melanocytes than people with paler skin - this is because darker skin is a sign of a generic origin in a country with more intense sunlight. Due to this melanocyte activity, the lighter your skin, the more likely your skin cells will be damaged by UV radiation - though, people of all skin colours can still develop skin cancer.

Generally speaking, this form of skin cancer will first appear as a mole. You should report any changes to existing moles or the appearance of new moles to your doctor urgently. If melanoma is not caught early, it can spread rapidly throughout the body, making it one of the more dangerous forms of skin cancer.

By far and large, the best way to protect yourself against melanoma is to avoid intense sunlight for prolonged periods - however, a small amount is still beneficial.

Non-melanoma

Unlike melanoma, non-melanoma skin cancers can affect every layer of the skin (except the melanocytes).

Basal cell carcinoma (BCC) is a form of skin cancer that affects the basal cells. Basal cells are located in the lowest section of the upper layer of the skin, the epidermis. The most common sub-category of skin cancer, BCC presents as round, pinkish growths. BCC will normally develop in sun-exposed areas, such as the face, head and neck.

Basal cells constantly divide, moving up the skin until they reach the surface where they become flat squamous cells. Squamous cell carcinoma (SCC) is cancer of the top layer of the epidermis. Generally, SCC is easier to remove than BCC due to its placement on the top of the skin - though, if it is not caught early it will spread faster. SCC will usually appear as a pink or red bump with a scaled surface, however, it may also present as open wounds that bleed and cannot heal.

Other, rarer non-melanoma forms of skin cancer include:

  • cutaneous T-cell lymphoma
  • dermatofibrosarcoma protuberans (DFSP)
  • Merkel cell carcinoma (MCC)
  • sebaceous carcinoma

The above cancers account for a tiny fraction of all cases. It is very unlikely you will develop any of these. However, as always, leave it to an expert in dermatology to rule out.

How do I get a diagnosis?

As you can imagine, the difference between the skin disorders briefly mentioned in this article is very slight. Really, the only way to determine if the cause of your skin imperfection is something innocuous like acne or keratosis pilaris, or something more serious like cancer, is to speak to a healthcare professional. A GP will be able to diagnose you, and if they have doubts, they will refer you to a dermatologist.

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