Many skin conditions can mimic acne vulgaris, and these are collectively known as acneiform eruptions. Such conditions include angiofibromas, epidermal cysts, flat warts, folliculitis, keratosis pilaris, milia, perioral dermatitis, and rosacea, among others. Age is one factor which may help distinguish between these disorders. Skin disorders such as perioral dermatitis and keratosis pilaris can appear similar to acne but tend to occur more frequently in childhood, whereas rosacea tends to occur more frequently in older adults. Facial redness triggered by heat or the consumption of alcohol or spicy food is suggestive of rosacea. The presence of comedones helps health professionals differentiate acne from skin disorders that are similar in appearance. Chloracne, due to exposure to certain chemicals, may look very similar to acne vulgaris.
Inflammatory Acne: Inflammatory acne is red bumps and pustules, not whiteheads, blackheads and comedones. It doesn't necessarily start as them, either. It arises on its own. Whiteheads, blackheads or comedones that become inflamed can be painful and unsightly. Persistent inflammatory acne may require treatment by a physician or dermatologist, in addition to over-the-counter acne remedies.
Hormonal activity, such as occurs during menstrual cycles and puberty, may contribute to the formation of acne. During puberty, an increase in sex hormones called androgens causes the skin follicle glands to grow larger and make more oily sebum. Several hormones have been linked to acne, including the androgens testosterone, dihydrotestosterone (DHT), and dehydroepiandrosterone (DHEA); high levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) have also been associated with worsened acne. Both androgens and IGF-1 seem to be essential for acne to occur, as acne does not develop in individuals with complete androgen insensitivity syndrome (CAIS) or Laron syndrome (insensitivity to GH, resulting in very low IGF-1 levels).
Hormonal fluctuations and an imbalance of estrogen and testosterone levels have proven to be a direct cause of acne. For this reason, many experience an onslaught of breakouts during puberty and pregnancy. The brain releases a GnRH hormone when an adolescent begins puberty, which in turn signals the pituitary gland to release two additional androgens. Androgens make the sebaceous glands produce more sebum, causing it to occupy too much space within the pore and preventing the full expulsion of dead skin cells and debris. Fluctuations in hormones also cause many women to experience acne during pregnancy and a worsening of breakouts during menstrual cycles.
But Accutane has mixed reviews for a reason. It makes the skin super dry and sensitive, which means it’s important to keep moisturizers and lip balm nearby while you’re on the treatment. Oh, and don’t even think about waxing your eyebrows (just imagine your skin ripping off). There’s another downside to Accutane: It requires a lot of paperwork and office visits. Since isotretinoin can cause birth defects, you have to come into the dermatologist once a month to get a pregnancy test and take a lengthy survey with embarrassing questions about your sex life to prove that you are using sufficient birth control. These precautions are intense, but dermatologists agree that the final results for Accutane are like no other. “This is one of the few medicines that I can look [patients] in the eye and guarantee them it will work,” says Friedman.
Retinoids and retinoid-like drugs. These come as creams, gels and lotions. Retinoid drugs are derived from vitamin A and include tretinoin (Avita, Retin-A, others), adapalene (Differin) and tazarotene (Tazorac, Avage). You apply this medication in the evening, beginning with three times a week, then daily as your skin becomes used to it. It works by preventing plugging of the hair follicles.