Acne Imposters

Some are simply unpleasant tagalongs, like dandruff; some may actually be mistaken for acne, but require a different course of treatment. Of course, only your dermatologist can make a conclusive diagnosis. But learning a little about these conditions may help you formulate questions for your doctor.

Acne cosmetica. As its name suggests, this mild and relatively common form of acne is caused by cosmetics. Since it's triggered by topical products, it can strike anyone — even people who are not physiologically prone to acne. It typically consists of small, itchy or rashy pink bumps on the cheeks, chin and forehead, developing gradually over the course of a few weeks or months. It may persist indefinitely, but usually does not cause scarring. How can you avoid it? When shopping for make-up and skin products, look for products that are "non-comedogenic." These products are less likely to cause irritation or clogging of the pores.

Dandruff (or Seborrheic Dermatitis). For reasons we don't know, dandruff often accompanies acne, especially in adolescents. The causes are similar. For dandruff sufferers, the natural process of scalp-cell renewal is accelerated when fighting off P. ovale, a normal fungus found on every human head. This causes dead cells to slough more quickly, creating the symptoms we know as dandruff — flaking, scaling and itching of the scalp. In some cases, dandruff involves tiny pimples on the scalp. Climate, heredity, diet, hormones and stress can also impact dandruff. Most cases can be managed with non-prescription shampoos containing zinc, coal tar or salicylic acid. Stronger shampoos can be prescribed by your doctor if the problem continues. Dandruff isn't caused by overwashing of the hair, so it's okay to shampoo every day. In contrast, scratching or picking the scalp can worsen the condition.

Dermatitis (or Eczema) is characterized by a rapidly spreading red rash which may be itchy, blistered and swollen. Atopic dermatitis is related to asthma and hay fever-type allergies, and is often seen in early childhood. Contact dermatitis is usually caused by contact with irritants (detergents or harsh chemicals) or allergens (substance to which the patient is allergic, like rubber, preservatives or a particular fragrance). Individuals with chronic dermatitis will have a longstanding history of irritation in the affected area or areas. The eyelids, neck and hands are most commonly affected in adults. The skin in these areas may be darker than surrounding skin, and thickened from persistent scratching. This form is thought to be hereditary, but may be influenced by environmental factors as well. Dermatitis may come and go throughout a person's life.

Enlarged pores. Before the onset of puberty, most people have relatively small pores and smooth skin. Pores tend to become larger in adolescence as sebum production increases. Then, as we continue to age, sun damage decreases the skin's elasticity, making pores appear larger. As an adult, the size of your pores is determined by genetics; some people retain the small pores of their youth, while others develop larger pores. Individuals with larger pores may complain of small grayish blackheads on the nose and cheeks. Contrary to popular belief, these "blackheads" are nothing more than normal sebum doing its job: lining the pore. Since the sebum is meant to be there, squeezing is an exercise in futility — the oil comes back the next day, and frequent handling over time may actually damage the pore, causing it to enlarge permanently.

Epidermal Cysts. Unlike cystic acne, which occurs within the confines of an infected follicle, an epidermal cyst is a sac-like growth in the deeper layers of the skin. The cyst sac is filled with a soft, whitish material that may remain indefinitely. Small cysts (less than 5mm in diameter) don't usually need treatment; they can be a nuisance, but are generally harmless. Larger cysts have a higher probability of becoming infected; this is very painful and can lead to scarring. Epidermal cysts are often permanent; even if the material is extracted, the sac remains and the cyst may return. In these cases the entire cyst sac must be excised to prevent recurrence. While cysts are typically benign, it's wise to consult a physician about suspicious lumps and bumps.

Favre-Racouchet Syndrome. Because this condition is caused by severe, progressive sun damage over the course of many years, Favre-Racouchet Syndrome is most prevalent among men and women over 50. Patients are afflicted by large coalescent comedones (blackheads) around the eyes and on the upper cheeks. Unlike acne blackheads, Favre comedones do not regress if left untreated; they must be surgically extracted or treated with topical retinoids.

Keratosis Pilaris. Common among teenagers, keratosis pilaris is characterized by patches of tiny, red, kernel-hard bumps on the backs of the arms, shoulders, buttocks and the front of the thighs. Occasionally it occurs on the cheeks as well, with numerous bumps in the affected areas. Unlike acne, keratosis pilaris is usually painless and feels spiny to the touch. It tends to be more severe during the winter months when humidity is lower, and is more prevalent in arid climates.

Milia. These tiny, white bumps are found mostly in the area around the eyes. Cystic in nature, they are hard to the touch and deep in the skin. Milia may last for weeks or even months; if they are particularly troublesome to you, consult your dermatologist for professional, safe removal.

Peri-Oral Dermatitis. Primarily affecting women in their 20s and 30s, this condition is characterized by patches of itchy or tender red spots around the mouth. The skin bordering the lips may appear pale and dry, while the chin, upper lips and cheeks become red, dry and flaky. It can also affect the skin around the nose.

Pseudofolliculitis barbae. Pseudofolliculitis barbae is just a fancy name for the acne-like breakouts commonly called "shaving bumps." As hairs begin to grow back after shaving, waxing or plucking, they get trapped inside the follicle and cause irritation and swelling. Not everyone gets shaving bumps; people with curly hair are more susceptible, but anyone can take steps to prevent them. If you can, use an electric razor. If you prefer blade shaving, use a new, single-edge blade every time you shave. Prep the area with warm water and use a rich shaving cream. Always shave with the grain, not against it. Then, after you're done, apply a mild toner or antibacterial gel. Get more information on shaving.

Rosacea. Frequently mistaken for acne, rosacea is a skin condition most commonly found in adults between 30 and 60 years of age. Unlike acne vulgaris, rosacea does not involve comedones, and appears only in areas that are likely to flush when we're embarrassed, excited or hot — primarily the face, neck and chest. The skin is bumpy, red and oily in appearance, and may also involve papules and pustules. Rosacea begins as an episodic inflammation, or a temporary annoyance. Left untreated, however, it can become a chronic condition, causing facial scarring. If you think you may have rosacea, it's best to contact a dermatologist right away.