Differential Diagnosis table forAcne vulgaris
| Condition | Differentiating signs/symptoms | Differentiating tests |
| Acne keloidalis nuchae |
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| Acneiform eruptions |
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Possible aetiologies to consider include oral medicines, topical corticosteroids, contrast dye, testosterone, and cosmetic products.
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Clinical clues include the abrupt onset of lesions within days of exposure, widespread involvement, atypical locations, atypical age, and improvement with cessation of medicine or exposure.
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| Chloracne |
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Comedones, pustules, and cysts are most commonly found behind the ears and in the axillae and groin.
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Consider exposure to halogenated aromatic hydrocarbons (e.g., chlorinated dioxins and dibenzofurans). Patient may have systemic complications such as ophthalmic, neuropathic, hepatic, and lipoprotein abnormalities.
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| Favre-Racouchot syndrome |
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Clinical differentiation usually suffices.
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Skin biopsy shows increased elastic tissue with thickened, tortuous fibres in the upper and mid-dermis.
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| Folliculitis (non-gram-negative) |
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Common condition that manifests as erythematous papules and pustules, which are follicularly based.
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As opposed to acne, folliculitis often affects the trunk and extremities.
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| Gram-negative folliculitis |
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Occurs in patients with acne treated with long-term antibiotics who subsequently develop pustules or nodules on the anterior nares, which then spreads. Can also occur in people after hot tub immersion, as well as in HIV patients.
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| Lupus miliaris disseminatus faciei |
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| Milia |
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| Peri-oral dermatitis |
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Common peri-oral eruption of papules and pustules on an erythematous and/or scaling base, often the result of topical corticosteroid use. Localised symmetrically around the mouth, with a clear zone around the vermilion border.
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| Pyoderma faciale |
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| Rosacea |
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Typically affects older people than acne vulgaris, most often women aged 30 to 50 years.
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Various forms, but classically presents with background erythema and telangiectasias, and inflammatory papules and pustules occasionally superimposed.
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Environmental factors often act as triggers.
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| Syringoma |
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Non-inflammatory small papules that occur primarily on the eyelids and upper cheeks, usually multiple.
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Disproportionately more prevalent in Japanese women.
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| Adenoma sebaceum (angiofibromas) |
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Small, translucent, waxy papules distributed symmetrically over the central cheek, nose, and forehead.
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Multiple lesions associated with tuberous sclerosis.
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