Is An Acne Clinic Right for You?
Nearly everyone gets mild to moderate acne1 between the ages of 8 and 18, and nearly every case of acne resolves on its own eventually even without medical care. Some people who have acne, however, need the services of a specialized acne clinic. And it’s also possible to have diseases that look like acne but that really aren’t—that may be a sign of something even more serious. Here is a list of the acne and acne-like conditions that require medical attention.
- Most people can manage mild to moderate common acne without ever seeing a doctor2. Some symptoms, however, require a doctor’s care.
- Any time acne emerges over trapped hairs, medical treatment is required.
- Perioral dermatitis causes eruptions of tiny pimples on the chin and around the corners of the mouth. Sometimes all that is needed is switching brands of toothpaste or mouthwash to a product that does not contain the ingredient SLS, but if that does not work, a doctor’s attention is advisable.
- Yeast infections and STDs can cause acne-like outbreaks.
- Any time pimples seem to burrow and merge, a doctor’s attention is required.
- If you have mild to moderate common acne, you may be helped by antibiotics or retinoid drugs prescribed by a doctor. Or you might get results that are just as good at far lower expense from a complete acne care system such as Exposed Skin Care.
An astonishing number of diseases cause acne-like or “acneiform” eruptions on the skin3 that require medical treatment, including:
- Eruptive vellus hair cysts4. Vellus hair is the fine, light-colored, nearly invisible hair that can grow between darker hairs on the skin. Sometime vellus hair follicles quit growing upward over the “bulb” at the bottom of the follicle that generates the hair, and a painless pimple erupts on the skin. This can happen to infants and seniors and at any age in between, although it’s a relatively rare condition.
- Pityrosporum folliculitis5, now also known as Malassezia folliculitis. Sometimes yeasts grow in the fatty acids that accumulate in pores of the skin. (Acne bacteria break down long-chain fatty acids into essential fatty acids, and the yeast in turn feed on the fatty acids.) The immune system tries to attack them with inflammation, with the result of itchy patches of pink skin forming in various locations on the body, although not usually the face.
- Perioral dermatitis6. Sometimes the use of toothpaste or mouthwash that contains sodium lauryl sulfate, also known as sodium dodecyl sulphate and SLS, can cause an outbreak of tiny pimples at the corners of the mouth and on the chin. This condition is closer to an allergy than it is to acne. It most commonly occurs in adult women.
- Coccidioidomycosis7, or San Joaquin Valley fever (not to be confused with the valley fever that occurs in Arizona). This condition is caused by an infection with a soil-borne fungus. The immune system’s reaction to the fungus causes fever, muscle aches, difficultly breathing, and an acne-like outbreak that can cover the body.
- Secondary syphilis8. The initial outbreak of syphilis occurs on the genital organs. Later outbreaks, however, can occur anywhere on the skin.
The most common acne-like infection, however, is impetigo. This skin infection can cause be caused by staph bacteria, which cause pimple-like eruptions on the skin that ooze a clear yellow fluid9, or by strep bacteria, which cause pimple-like eruptions on the skin that ooze a fluid the color and consistency of honey.
Treatments for acne will not usually help these conditions, and may make them worse. If you have acne-like outbreaks on the skin which don’t respond to your usual acne care, see a doctor for advice.
Acne conglobata10 “burrows” between pimples to form large sores on the face, back, chest, and buttocks. It can strike between birth and the age of 30, and it cannot be treated by conventional acne medications. Laser resurfacing may help relieve scars.
Dermatitis herpetiformis11 is caused by sensitivity to a protein called gliadin, found in gluten in wheat and certain other cereal grains. Much as celiac disease causes severe irritation of the bowel, dermatitis herpetiformis causes severe irritation of the skin. Medications that shut down the inflammation function of the immune system, such as dapsone, are usually required to bring the condition under control.
Many people who don’t have acne as teenagers develop cystic acne in their early 20’s. Usually striking young people with otherwise healthy brown skin, cysts form when rapidly growing skin envelops acne bacteria in pores. The immune system tries to remove bacteria with inflammation, but the bacteria secrete a chemical that redirects the effects of inflammation to nearby skin cells. The cyst grows larger and larger because the acne bacteria are not killed but cannot escape.
Cystic acne used to be treated by lancing. Nowadays it is treated with retinoid drugs12 like Accutane and
Retin-A. Safe use of these medications, however, requires medical supervision. Never try to pop or lance cysts on your own. Permanent scarring and even worse infections can result.
Rosacea is a condition of “pimpling” of the skin on the nose, across the cheeks, and around the eyes. Capillaries leak blood when they are filled with blood, creating tiny red spots on the skin. After a period of years, scar tissue can build up around these capillaries and cause the formation of tiny bumps under the skin, especially under the skin of the nose. You may be able to control rosacea outbreaks on your own, but you will need the assistance of a physician to treat rhinophyma13, or “bumpy nose.”
When to See a Doctor About Everyday Acne
You can probably manage everyday acne on your own without ever seeing a dermatologist, but there are things a doctor can do for you that you cannot do for yourself14:
- If your primary problem is pimples, rather than whiteheads or blackheads, your doctor may be able to prescribe an antibiotic to help bring acne infection under control.
- If you have problems with scars or pigmentation of the skin, laser resurfacing therapies may bring about a faster resolution of skin issues than treatments you can do on your own.
- If you have acne at a deeper level of your skin, your doctor may be able to recommend retinoid drugs that will accelerate healing.
And sometimes your dermatologist can treat “cosmetic emergencies.” Your doctor may be able to give you a steroid injection directly into a pimple to make it less prominent and less noticeable before a special occasion.
- Stathakis V, Kilkenny M, Marks R. Descriptive epidemiology of acne vulgaris in the community. Australas J Dermatol. 1997 Aug;38(3):115-23.
- Nair PA, Salazar FJ. Acneiform Eruptions. [Updated 2018 Dec 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan.
- Nair PA, Salazar FJ. Acneiform Eruptions. [Updated 2018 Dec 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.
- Anand P, Sarin N, Misri R, Khurana VK. Eruptive Vellus Hair Cyst: An Uncommon and Underdiagnosed Entity. Int J Trichology. 2018 Jan-Feb;10(1):31-33.
- . Rubenstein RM, Malerich SA. Malassezia (pityrosporum) folliculitis. J Clin Aesthet Dermatol. 2014 Mar;7(3):37-41.
- Tolaymat L, Hall MR. Dermatitis, Perioral. [Updated 2018 Oct 27]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.
- Akram SM, Koirala J. Coccidioidomycosis. [Updated 2019 Feb 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.
- Marchand-Senécal X, Barkati S, Bouffard D, Martel-Laferrière V. A secondary syphilis rash with scaly target lesions. Oxf Med Case Reports. 2018 Feb 1;2018(2):omx089.
- Pereira LB. Impetigo – review. An Bras Dermatol. 2014 Mar-Apr;89(2):293-9
- Hafsi W, Badri T. Acne Conglobata. Treasure Island (FL): StatPearls Publishing; 2019 May 2.
- Salmi TT. Dermatitis herpetiformis. Clin Exp Dermatol. 2019 May 15.
- Costa CS, Bagatin E, Martimbianco ALC, da Silva EMK, Lúcio MM, Magin P, Riera RCosta CS, Bagatin E, Martimbianco ALC, da Silva EMK, Lúcio MM, Magin P, Riera R.Oral isotretinoin for acne.Cochrane Database of Systematic Reviews2018, Issue 11. Art. No.: CD009435
- Mikkelsen CS, Holmgren HR, Kjellman P, Heidenheim M, Kappinnen A, Bjerring P, Huldt-Nystrøm T. Rosacea: a Clinical Review. Dermatol Reports. 2016 Jun 23;8(1):6387.
- When to seek medical treatment for acne [Internet]. Mymed.com. 2019.
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