Not all that looks like acne is indeed acne.

I saw a patient recently. She had some lesions that were itchy and erupted in a short period. Most of the lesions were extensive on her face, chest, back and upper arms. The itching was so much and prevented her from sleeping well. It was already affecting her self esteem. She had seen two aestheticians who had given her the routine acne treatment and some other beauty products.

She saw the second aesthetician a few weeks after the first. Yet she was getting worse.

When I saw her, she was getting frustrated already and was at her wit’s end. The first thing I noticed was the almost monomorphic appearance of the lesions (they were all about the same size).

The next thing I noticed was how itchy they were because she kept scratching them. These are not in keeping with straight forward acne. She had some lesions that were comedonal (typical lesions of acne) but most were not. On further questioning, she occasionally has acne especially during her period but nothing like this present one.

Things to note –

-Acne is not typically itchy. Some patients with adult acne may complain of itching (acne in patients over 25years) but not intensely so.

– Acne is POLYMORPHIC – You’ll see lesions of different sizes. Once you have all of them looking alike, consider something else like Malassezia folliculitis  (caused by a fungi) and other forms of folliculitis like Demodex folliculitis which is a mite.

Steroid induced acne will also appear monomorphic (all of you applying triple action creams on your skin, you’ll soon start to see some tiny lesions that look like heat rash /pimples all over your face. Your face will probably be lighter than your normal skin already because of the high potency steroids in the triple action creams).

This patient was treated for malassezia folliculitis and acne. By the 3rd day of commencing treatment, she sent me a message thanking me profusely. She’s doing much better and her skin has improved significantly.

It is important to note that not everything that looks like acne is acne. Remember the polymorphic nature of acne. If you start treatment of acne, some patients may not tolerate topical medications of acne like benzoyl peroxide or even salicylic acid and you may need to switch to other things like azelaic acid. Remember to moisturize the skin.

Dear aesthetician, refer patient if you have treated properly and there’s no improvement. Know when to refer. Don’t take on cases that is outside your forte.

Not everything that looks like acne…is acne.