Differential diagnosis

Possible items in the differential for this condition include:

• drug eruptions eg in response to anti-tuberculous or anti-epileptic therapy
• rosacea - but usually affect an older age group and there is an absence of comedones, nodules or scarring (1)
• pyogenic folliculitis - swabs usually yield Staphylococcus aureus in this condition
• perioral dermatitis- it can present with acneiform or eczematous features. The perioral distribution is the best clue to its differentiation (1)
• Demodex folliculitis and pityrosporum folliculitis - are caused by mites and yeast-like organisms respectively. Should be suspected when the acne doesn't respond to appropriate therapy (1).
• in infantile form: the possibility of an androgen secreting tumour must be excluded.

Reference:

1. National Institute for Health and Care Excellence. Acne vulgaris. Dec 2023 [internet publication].