Boston Cosmetic
Boston Cosmetic

















Boston Cosmetic

Acne Imposters

The following skin lesions can be mistaken as the common Acne Vulgaris by a less experienced provider, but require their own specific course of treatment. Misdiagnosis and hiding_behind_maskmistreatment of some of these diseases as acne can lead to serious cosmetic as well as general health compromise. Of course, Dr. Edwin Ishoo and the experienced staff at Boston Cosmetic Specialists can make a conclusive diagnosis and start you on the appropriate treatment. But learning a little about the following conditions may help you formulate questions for your provider especially if your acne does not seem to be responding to treatment.

  1. Dermatitis (or Eczema):  presents as a rapidly growing, itchy red rash with blisters and swelling. Atopic dermatitis is often seen in childhood. Contact dermatitis is caused by contact with irritants (detergents as well as harsh chemicals) or ingredients (substance to which the actual patient is allergic, similar to rubber, preservatives or per particular fragrance). Individuals with chronic dermatitis have a history of longstanding irritation of the affected areas which are most commonly eyelids, neck and hands in adults. The skin in the affected areas is generally darker or more ecchymotic and thickened due to chronic scratching. This is thought to be hereditary, but may be influenced by environmental factors. Dermatitis may come and go for the remainder of a person’s life.
  2. Enlarged pores: Before the beginning of puberty, the pores of hair follicles are small and the skin surface appears smooth. Skin pores tend to become larger in adolescence as sebum production increases. T Aging and sun damage decrease the skin’s elasticity, making pores appear larger. Individuals with larger pores may complain of small grayish blackheads on the nasal and cheek skin.
  3. Epidermal Cysts: Unlike cystic acne, which occurs within this particular confines of an afflicted follicle, an epidermal cysts is a sac-like creation in the deeper sections of the skin. The cyst sac is filled with a soft, creamy colored material that may keep living indefinitely. Small cysts (less than 5mm in diameter) don’t usually need treatment; they can be a nuisance, but are most likely harmless. Larger cysts have a higher probability of becoming infected; this is very painful and leads to scarring. Epidermal growths are often permanent; even if the material is extracted, the sac remains and additionally the cyst may return. In these cases the all round cyst sac must stay excised to prevent repeat. While cysts are typically benign, it’s wise to look for advice a physician about suspicious lumps and bumps.
  4. Favre-Racouchet Syndrome: This is an acne-like break out common among men and women over the age of 50 caused by severe, progressive sun damage over many years. The lesions present as a close group of blackheads around the eyes and upper cheeks. However, unlike acne vulgaris, Favre comedones do not regress if left untreated and require surgical extraction or targeted treatment with topical retinoids.
  5. Keratosis Pilaris: Acne isn’t the only condition that results in red, raised bumps on the skin. If your bumps are small, rough, and look like patches of goose bumps on your arms, back, and/or thighs, chances are it’s not acne but keratosis pilaris, a condition that affects up to 40 percent of the population. Common among teenagers, keratosis pilaris is categorized by patches of tiny, red, kernel-hard papules in the backs of the arms, shoulders, buttocks and this particular front of the thighs and legs. Occasionally it occurs on cheeks as well, in numerous bumps in each affected areas. Unlike acne, keratosis pilaris is often painless and feels spiny and keratotic to the touch and are typically skin colored. The roughness tends to be a bit more severe during the winter months when humidity is lower, and is more prevalent in dry climes. Keratosis pilaris generally disappears by age 30, but many people struggle with this annoying, but harmless skin condition well into adulthood. Like acne, keratosis pilaris is an inherited disorder of the hair follicles and may be associated with atopic dermatitis. It is not contagious. It occurs when the body overproduces keratin and forms hard plugs on the skin’s surface.
  6. Dandruff (or Seborrheic Dermatitis): Dandruff often accompanies acne, especially in adolescents. The most important causes are similar. Dandruff is due to the natural process of scalp-skin repair and regeneration,which is accelerated when fighting off P. ovale, a normal fungus found on every human head. This infestation causes dead skin cells to slough more quickly from the scalp, thus causing flaking, scaling and itching which describes dandruff. In some individuals, dandruff presents as small pimples on the head. Climate, heredity, diet, hormones and stress can contribute to cause or worsening of dandruff. Most conditions can be managed with non-prescription shampoos containing zinc, coal, or salicylic acid. Persistent dandruff may require prescription shampoos. Persistent irritation of scalp may worsen the dermatitis and the accompanying acne if the dermatitis is not properly recognized and adequately treated.
  7. Milia: A common skin rash that causes pink or red bumps resembling small cyctic pimples on the skin. However, they may very well be hard to touch and deep in the skin. More commonly known as heat rash, Milia occurs when the skin becomes overheated and the sweat glands become obstructed and inflamed. The rash often itches. Although most common in babies and young children, it can appear at any age. Milia may last weeks or even months. Dr. Ishoo and his staff of acne certified specialists are experienced in diagnosis and safe removal of Milia.
  8. Peri-Oral Dermatitis: Primarily affecting women in their 20s and thus 30s, this condition is characterized by patches relating to itchy or tender red spots around the lips. The skin bordering the mouth may appear pale and furthermore dry, while the chin, upper lips and cheekbones become red, dry as flaky. It can palso involve the skin around the nose. Perioral dermatitis is a self-limited condition which will typically resolve within a few months without pharmacological therapy. However, many patients request treatment for cosmetic reasons. Dr. Ishoo at Boston Acne Center provides diagnosis and treatment of this condition using selected and antibiotics to help expedite recovery and reduce risk of scarring from chronic irritation.
  9. Pseudofolliculitis barbae: Also known as “shaving bumps” or “barber’s itch”, it starts when hair follicles are damaged by friction from clothing, blockage of the follicle, or shaving, waxing or plucking. Subsequently, when hairs begin to grow back they get trapped inside the hair follicle and get infected with the bacteria Staphylococcus (staph), causing rash, itching, pimples or pustules which may crust over. Pseudofolliculitis barbae is a disorder that occurs mainly in black men. If curly beard hairs are cut too short, they may curve back into the skin and cause inflammation.
  10. Gram-Negative Folliculitis:Gram-negative Folliculitis is a bacterial infection that is characterized by cysts and pustules. This type of acne is a complication of extended antibiotic treatment of acne vulgaris. This type of acne is rare. Gram-Negative Folliculitis is responsive to treatment. Sometimes complication leads to long term treatment from antibiotics for acne vulgaris. Also we cannot say if this is common in female and male or either of them but often the treatment given to this is isotretinoin.
  11. Staph Infections (Carbunculosis): Staph Infections on the face or the body can look much like red, swollen acne pimples or boils with pus, but staph is much more severe than acne. One way to tell the difference is that the staph will not have symmetrical borders like a pimple or a pustule does and the pimples can open and lead to crusty skin or red, swollen skin that’s hot to the touch. Occasionally the individual will complain of fever and fatigue. If staph infection is misdiagnosed and mistreated, it can cause significant harm to your general health. This condition should be treated by a physician and not by facials and extractions in a salon or spa. It often will not respond to typical acne products and/or treatments and may worsen. It needs to be treated with the correct antibiotics in order to get it under control.
  12. Hidradenitis Suppurativa- Acne Inversa: These lesions commonly occur around hair follicles and present as large, red bumps filled with pus that typically develop where skin rubs together — such as arm pits, groin, between the buttocks and under the breasts which are usually painful and may break open and drain foul-smelling pus. Hidradenitis suppurativa tends to start after puberty, persist for years and worsen over time. For some people, the disease progressively worsens and affects multiple areas of their body. Other people experience only mild symptoms. Excess weight, stress, hormonal changes, heat or excessive perspiration can worsen symptoms. Early diagnosis and treatment of hidradenitis suppurativa can help manage the symptoms and prevent new lesions from developing. HS is a long-term skin disease, which often goes undiagnosed. The earlier it is diagnosed, the better the outcome. HS can be disabling without treatment.
  13. Malassenzia Folliculitis:  formerly known as Pityrosporum folliculitis, It is an inflammation of the hair follicles most often caused by a fungal or yeast (fungi) of the genus Malasseziathat which can look just like acne. It can be caused from the extended use of antibiotics, the use of steroids, oily skin, humidity, occlusive clothing, heavy moisturizers and the use of hot tubs/spas. It can remain dormant for long periods of time and then flare up with humid weather and it often “comes and goes”. There are bacterial forms as well and one must be tested to know which it is. It looks like small, non-inflamed bumps that frequently shows up on the forehead, but can be anywhere on the face or body. It is not uncommon for folliculitis to occur with acne, but treatment must be modified to be effective.

The proper diagnosis of any skin disease, including Acne is critical to your appearance and health. Don’t risk permanent scarring or your health by having your skin disease treated at a spa. Contact your dermatologist or Boston Cosmetic Specialists for a complementary consultation with Dr. Edwin Ishoo.