Unmasking Four Potential Mimickers of Acne or Rosacea Dermatologists usually diagnose the following conditions with ease, but patients may be convinced they have acne or rosacea.
By Dina Anderson, MD
ecause acne is so widespread, it necessary in rare instances. Topical patient manipulation or other trauma. is the average patient’s default skincare should include a soap-free Milia typically resolve on their own Bdiagnosis for any red, bumpy moisturizing cleanser and an oil-free with no intervention. Some may be facial skin condition. Many patients daily moisturizer containing sunscreens. persistent, or patients may request incorrectly believe that even rosacea is Perioraficial dermatitis. removal for cosmetic reasons. Topical simply “adult acne.” Sometimes considered a subtype of skin creams and cleansers are marketed Following is a look at some acne rosacea, this condition occurs frequent- but offer little benefit. The most expe- and/or rosacea mimickers and their ly in children but also occurs in women dient remedy for milia is extraction: treatment. Educating patients about the and men. Characterized by tiny inflam- Milia/Milium are treated by puncturing nature of these conditions and distin- matory papules, it occurs in a charac- the skin with a 30-gauge needle fol- guishing them from acne or rosacea teristic distribution around the orifices lowed by removal using a comedone may improve compliance and minimize of the face. Comedones are absent. extractor. Regular use of a topical the likelihood that patients will try to Periorificial dermatitis can look granu- retinoids, glycolic acid, or salicylic acid add-on “remedies” that may actually lomatous and is commonly misdiag- products may help to prevent recur- exacerbate their presentation. nosed as an allergic reaction when it rence of milia. Perioral Dermatitis. Derma- only occurs by the corners of the eye. Keratosis pilaris rubra faceii tologists are familiar with perioral der- Any of the topical agents commonly (KPRF). This variant of KP is character- matitis, which, as its name suggests, used for rosacea may treat this condi- ized by tiny, flesh-colored papules on a occurs around the mouth and may tion, however oral antibiotics may be background of erythema, often develop- involve the nasolabial folds. It is a pres- indicated. Maintain therapy for several ing during adolescence. The condition is entation exclusive to women. weeks and advise patients to be vigilant sometimes mistaken for acne or rosacea Sometimes mistaken for an allergic for signs of recurrence. Institution of by patients. Many affected individuals contact reaction, perioral dermatitis topical therapy at the first signs of are distressed by the highly visible pres- spares the vermillion; an allergic con- recurrence may hold a flare at bay. entation. tact reaction will not. Although not studied, anti-inflam- Treatment options are limited. KTP Inflammatory papules can be matory dose doxycycline (Oracea, or pulsed dye laser or IPL can help calmed with sulfur based topical for- CollaGenex) may be a reasonable sys- KPRF. Topical antioxidants can also mulations or masks. Oral tetracyclines temic option to manage recurrent or help diminish persistent erythema. represent the best treatment option for persistent perioraficial dermatitis. Typical topical acne therapies, like this condition. Many patients will have Milia. Milia on the face can be a retinoids and benzoyl peroxide, tend to attempted therapy with over-the-count- persistent and troubling presentation. irritate the condition. Topical therapies er remedies, sometimes including topi- Though not a form of acne, milia may containing lactic acid, glycolic acid, or cal corticosteroids. Improper therapies be mistaken for whiteheads by patients. salicylic acid can help improve texture may exacerbate inflammation or, in the They are common around the eye but and minimize the “bumpy” quality of case of corticosteroids, contribute to can occur at other sites. Though inflam- follicular spines. The same camouflage the presentation by inducing “steroid mation is not a component of the techniques used in rosacea (such as acne.” Patients must discontinue all pathogenesis of these tiny pockets of green-tinted make-up) will benefit inter- topical therapies. To avoid a vigorous sebum and keratinocytes trapped within ested patients. The condition seems to flare, tapering of the steroid may be the follicle, erythema may result from resolve as patients age.
December 2007 Practical Dermatology 19