When you notice a spot or bump on your face, it’s easy to assume it’s acne, especially if you’re prone to breakouts. However, not all facial blemishes are caused by acne. Sometimes, these look-alikes are actually different types of skin conditions that require entirely different treatments. Spotting the difference can make a world of difference in achieving clear skin, as treating these conditions incorrectly might make them worse rather than better. With a bit of insight, you’ll be able to tell if you’re dealing with acne or a similar rash – and take steps to address it properly.
Below, we explore some common skin issues that can resemble acne and understand how to recognise and treat them effectively. This way, you’ll know if it’s time to adjust your skincare routine, seek out a skin doctor, or adopt a more specialised approach.
Acne is one of the most common skin conditions, affecting millions of people worldwide. It’s primarily caused by clogged pores, which happen when excess oil, dirt, or dead skin cells block the hair follicles. This environment creates the perfect breeding ground for the acne-causing bacteria Cutibacterium acnes (previously called Propionibacterium acnes), leading to those pesky red or white bumps.
There are various types of acne, including whiteheads, blackheads, pustules, and cysts. Each type presents differently, but they generally appear in areas with higher oil production, like the face, back, and chest. Acne-prone skin often shows inflamed spots, comedones (white- and black-heads), and an oily texture.
Rosacea (Figure 1) is a chronic skin condition that can often be mistaken for acne. Unlike acne, rosacea isn’t triggered by clogged pores; instead, rosacea is thought to arise due to a complex interplay amongst factors such as Dermodex mites, ultraviolet radiation, and the immune system.
Figure 1: Rosacea
Rosacea causes persistent redness and visible blood vessels, especially across the cheeks and nose. Many people with rosacea also experience acne-like bumps, which can make it easy to confuse the two.
Rosacea is often triggered by things like sunlight, heat, spicy foods, or stress. You can usually tell it’s rosacea if there’s a consistent red flush and absence of blackheads or whiteheads. Treatment usually involves avoiding common triggers and may include prescription creams like ivermectin, metronidazole, or azelaic acid to manage symptoms. In severe cases, patients may require oral antibiotics or retinoids.
If you notice red, small bumps around your mouth and chin, there’s a chance it might be perioral dermatitis (Figure 2) instead of acne. This condition is a form of facial rash that’s often related to overusing topical steroids or certain skincare products. It can even appear around the nose and eyes, in which case the condition is more appropriately called peri-orifical dermatitis.
Figure 2: Perioral dermatitis
Perioral dermatitis is characterised by many small red bumps around the mouth, on the chin, and sometimes around the nose and eyes. Sometimes the skin can also appear dry and flaky. The absence of comedones (whiteheads and blackheads) and typical distribution of the rash helps one differentiate this from acne.
Treatment often involves slowly reducing topical steroid use and adopting a gentle skincare routine. Patients may experience flare-ups as topical steroid creams are weaned off. They may need medications such as topical antibiotic creams or non-steroidal anti-inflammatory creams (such as tacrolimus or pimecrolimus) to control the inflammation.
Another tricky skin condition to recognise is fungal acne, also known as Malassezia (pityrosporum) folliculitis. Despite its name, fungal acne isn’t true acne. It’s actually a skin issue caused by an overgrowth of yeast, which is especially common in hot, humid climates like Singapore. This yeast overgrowth leads to itchy, acne-like bumps that can appear on the neck, chest, and back.
Figure 3: Malassezia folliculitis
Unlike traditional acne, fungal acne bumps are typically uniform in size, and they tend to be itchy rather than painful. Traditional acne treatments don’t work on fungal acne; instead, antifungal creams or oral medications are necessary to clear it up. Adjusting your skincare routine to control excess oil and avoid yeast-friendly products can also help prevent future breakouts.
Gram-negative folliculitis is a rare but frustrating condition where “acne” flares paradoxically while on antibiotics. This condition arises from an overgrowth of gram-negative bacteria (such as Klebsiella, Escherichia, and Serratia species) due to a disturbed skin microbiome. If you’ve been on antibiotics for acne treatment and your skin seems to be getting worse, it’s possible that you might be experiencing gram-negative folliculitis.
This condition can be hard to distinguish from regular acne, so it’s best to consult a skin doctor in Singapore who can accurately diagnose and recommend the right course of treatment. Switching to an appropriate skincare routine and changing to an antibiotic that targets the gram-negative bacteria will help to calm the inflammation and prevent scarring.
Steroid acne, or an acneiform eruption, is another condition that can mimic acne but has a different origin. It’s commonly caused by the inappropriate use of steroid creams, either prescribed for other skin issues or used to treat unrelated conditions. Sometimes, patients may be using creams from doctors that contain a combination of steroids, antibiotics, and anti-fungal medicines, or from unlicensed sources that contain steroids.
Steroid acne usually appears as red, inflamed bumps and may be scattered across the face, neck, and trunk. These bumps may be itchy, and can be differentiated from the usual acne by the absence of comedones (whiteheads or blackheads) and uniformity of the red bumps (all appearing around the same size and shade of red).
The best way to handle steroid acne is by discontinuing the use of the offending steroid product. However, stopping steroids abruptly isn’t always recommended as it may result in a flare of the underlying condition for which the steroids were prescribed. It may be necessary to taper off the steroid gradually under the guidance of a dermatologist.
The acne-like bumps should subside with time once steroid use is stopped, and a dermatologist can often prescribe antibiotics or isotretinoin which will hasten the recovery and prevent scarring.
Skincare can be tricky, especially when dealing with acne and its look-alikes. A good place to start is by tailoring your skincare routine based on your skin type. For instance, if you have oily skin, products formulated to reduce excess oil without stripping your skin may be beneficial. On the other hand, dry skin types might need gentler, hydrating products that won’t aggravate sensitive areas.
Identifying skin issues correctly is essential for effective treatment. Mistaking a condition like fungal acne or rosacea as traditional acne can delay proper care, making symptoms worse. Many people find that consulting a skin doctor helps them better understand their skin and avoid potential missteps in treatment. With expert guidance, you can achieve clear, healthy skin by addressing underlying issues instead of just treating symptoms.
When you’re faced with facial blemishes, it’s essential to know what you’re dealing with before jumping into treatments. Conditions like rosacea, perioral dermatitis, and fungal acne can easily mimic acne but need unique care approaches. Consulting with professionals, such as the compassionate team at TSN Dermatology, ensures you receive high-quality care tailored to your skin’s specific needs. Getting the right diagnosis and treatment plan can make a huge difference, helping you achieve the clear and healthy skin you deserve.
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