Acne vulgaris differential diagnosis: Difference between revisions

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==Differentiating Acne Vulgaris from other Diseases==
==Differentiating Acne Vulgaris from other Diseases==
Different [[rash]]-like conditions may be misdiagnosed with [[acne]], including:<ref name="MooreSeward2006">{{cite journal|last1=Moore|first1=Zack S|last2=Seward|first2=Jane F|last3=Lane|first3=J Michael|title=Smallpox|journal=The Lancet|volume=367|issue=9508|year=2006|pages=425–435|issn=01406736|doi=10.1016/S0140-6736(06)68143-9}}</ref>
Different [[rash]]-like conditions can be confused with [[acne]] and are thus included in its differential diagnosis. The various conditions that should be differentiated from [[acne]] include:<ref name="pmid25250996">{{cite journal| author=Hartman-Adams H, Banvard C, Juckett G| title=Impetigo: diagnosis and treatment. | journal=Am Fam Physician | year= 2014 | volume= 90 | issue= 4 | pages= 229-35 | pmid=25250996 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25250996  }} </ref><ref name="pmid27265069">{{cite journal| author=Mehta N, Chen KK, Kroumpouzos G| title=Skin disease in pregnancy: The approach of the obstetric medicine physician. | journal=Clin Dermatol | year= 2016 | volume= 34 | issue= 3 | pages= 320-6 | pmid=27265069 | doi=10.1016/j.clindermatol.2016.02.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27265069  }} </ref><ref name="MooreSeward2006">{{cite journal|last1=Moore|first1=Zack S|last2=Seward|first2=Jane F|last3=Lane|first3=J Michael|title=Smallpox|journal=The Lancet|volume=367|issue=9508|year=2006|pages=425–435|issn=01406736|doi=10.1016/S0140-6736(06)68143-9}}</ref><ref name="pmid26612370">{{cite journal| author=Ibrahim F, Khan T, Pujalte GG| title=Bacterial Skin Infections. | journal=Prim Care | year= 2015 | volume= 42 | issue= 4 | pages= 485-99 | pmid=26612370 | doi=10.1016/j.pop.2015.08.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26612370  }} </ref><ref name="pmid26566601">{{cite journal| author=Ramoni S, Boneschi V, Cusini M| title=Syphilis as "the great imitator": a case of impetiginoid syphiloderm. | journal=Int J Dermatol | year= 2016 | volume= 55 | issue= 3 | pages= e162-3 | pmid=26566601 | doi=10.1111/ijd.13072 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26566601  }} </ref><ref name="pmid25855021">{{cite journal| author=Kimura U, Yokoyama K, Hiruma M, Kano R, Takamori K, Suga Y| title=Tinea faciei caused by Trichophyton mentagrophytes (molecular type Arthroderma benhamiae ) mimics impetigo : a case report and literature review of cases in Japan. | journal=Med Mycol J | year= 2015 | volume= 56 | issue= 1 | pages= E1-5 | pmid=25855021 | doi=10.3314/mmj.56.E1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25855021  }} </ref><ref name="pmid23176858">{{cite journal| author=CEDEF| title=[Item 87--Mucocutaneous bacterial infections]. | journal=Ann Dermatol Venereol | year= 2012 | volume= 139 | issue= 11 Suppl | pages= A32-9 | pmid=23176858 | doi=10.1016/j.annder.2012.01.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23176858  }} </ref>
*[[Insect bite]]s - In an [[insect bite]], the insect injects [[formic acid]], which can cause an immediate [[skin]] reaction often resulting in a [[rash]] and swelling in the injured area, often with formation of [[vesicles]].


*[[Kawasaki disease]] - commonly presents with high and persistent [[fever]], red [[mucous membranes]] in mouth, "[[strawberry tongue]]", [[swollen lymph nodes]] and [[skin rash]] in early disease, with peeling off of the [[skin]] of the [[hands]], [[feet]] and [[genital area]].
{| class="wikitable"
 
! style="width: 200px; background: #4479BA; text-align: center;"| {{fontcolor|#FFF|Disease}}
*[[Measles]] - commonly presents with high [[fever]], [[coryza]] and [[conjunctivitis]], with observation of [[oral mucosa|oral mucosal]] lesions ([[Koplik's spots]]), followed by widespread [[skin rash]].
! style="width: 200px; background: #4479BA; text-align: center;"| {{fontcolor|#FFF|Features}}
 
|-
*[[Monkeypox]] - presentation is similar to [[smallpox]], although it is often a milder form, with [[fever]], [[headache]], [[myalgia]], [[back pain]], [[swollen lymph nodes]], a general feeling of discomfort, and exhaustion. Within 1 to 3 days (sometimes longer) after the appearance of [[fever]], the patient develops a papular [[rash]], often first on the face. The lesions usually develop through several stages before crusting and falling off.
| style="background: #DCDCDC; padding: 5px;"|[[Impetigo]] 
 
|
*[[Rubella]] - commonly presents with a facial [[rash]] which then spreads to the [[trunk]] and [[limbs]], fading after 3 days, low grade [[fever]], swollen [[glands]], [[joint pain]]s, [[headache]] and [[conjunctivitis]]. The [[rash]] disappears after a few days with no staining or peeling of the [[skin]]. ''[[Forchheimer's sign]]'' occurs in 20% of cases, and is characterized by small, red [[papules]] on the area of the [[soft palate]].
*It commonly presents with pimple-like lesions surrounded by [[erythematous]] [[skin]]. Lesions are [[pustules]], filled with [[pus]], which then break down over 4-6 days and form a thick crust. It's often associated with insect bites, cuts, and other forms of [[trauma]] to the [[skin]].
 
|-
*Atypical [[measles]] - symptoms commonly begin about 7-14 days after infection and present as [[fever]], [[cough]], [[coryza]] and [[conjunctivitis]]. Observation of [[Koplik's spots]] is also a characteristic finding in measles.
| style="background: #DCDCDC; padding: 5px;"|[[Insect bite]]s
 
|
*[[Coxsackievirus]] - the most commonly caused disease is the [[Coxsackie A]] disease, presenting as ''hand, foot and mouth disease''. It may be [[asymptomatic]] or cause mild [[symptoms]], or it may produce [[fever]] and painful [[blisters]] in the mouth ([[herpangina]]), on the palms and fingers of the hand, or on the soles of the feet. There can also be [[blisters]] in the [[throat]] or above the [[tonsils]]. Adults can also be affected. The [[rash]], which can appear several days after high temperature and painful sore throat, can be itchy and painful, especially on the hands/fingers and bottom of feet.
* The insect injects [[formic acid]], which can cause an immediate [[skin]] reaction often resulting in a [[rash]] and swelling in the injured area, often with formation of [[vesicles]].
 
|-
*[[Syphilis]] - commonly presents with gneralized systemic [[symptoms]] such as [[malaise]], [[fatigue]], [[headache]] and [[fever]]. [[Skin]] eruptions may be subtle and [[asymptomatic]] Classically described as 1) non-pruritic bilateral symmetrical mucocutaneous [[rash]]; 2) non-tender regional [[lymphadenopathy]]; 3) condylomata lata; and 4) patchy [[alopecia]].
| style="background: #DCDCDC; padding: 5px;"|[[Kawasaki disease]]  
 
|
*[[Molluscum contagiosum]] -  lesions are commonly flesh-colored, dome-shaped, and pearly in appearance. They are often 1-5 millimeters in diameter, with a dimpled center. Generally not painful, but they may itch or become irritated. Picking or scratching the lesions may lead to further [[infection]] or scarring. In about 10% of the cases, [[eczema]] develops around the lesions. They may occasionally be complicated by secondary [[bacterial infections]].
* Commonly presents with high and persistent [[fever]], red [[mucous membranes]] in mouth, "[[strawberry tongue]]", [[swollen lymph nodes]] and [[skin rash]] in early disease, with peeling off of the [[skin]] of the [[hands]], [[feet]] and [[genital area]].
 
|-
*[[Mononucleosis]] - Common [[symptoms]] include low-grade [[fever]] without [[chills]], [[sore throat]], white patches on [[tonsils]] and back of the throat, [[muscle weakness]] and sometime extreme [[fatigue]], tender [[lymphadenopathy]], [[petechial hemorrhage]] and [[skin rash]].
| style="background: #DCDCDC; padding: 5px;"|[[Measles]]  
 
|
*Toxic [[erythema]] - common [[rash]] in infants, with clustered and [[vesicular]] appearance.
* Commonly presents with high [[fever]], [[coryza]] and [[conjunctivitis]], with observation of [[oral mucosa|oral mucosal]] lesions ([[Koplik's spots]]), followed by widespread [[skin rash]].
 
|-
*[[Rat-bite fever]] - commonly presents with [[fever]], [[chills]], open sore at the site of the bite and [[rash]], which may show red or purple plaques.
| style="background: #DCDCDC; padding: 5px;"|[[Monkeypox]]
 
|
*[[Parvovirus B19]] - the [[rash]] of fifth disease is typically described as "slapped cheeks," with [[erythema]] across the cheeks and sparing the nasolabial folds, forehead, and mouth.
* The presentation is similar to [[smallpox]], although it is often a milder form, with [[fever]], [[headache]], [[myalgia]], [[back pain]], [[swollen lymph nodes]], a general feeling of discomfort, and exhaustion. Within 1 to 3 days (sometimes longer) after the appearance of [[fever]], the patient develops a papular [[rash]], often first on the face. The lesions usually develop through several stages before crusting and falling off.
 
|-
*[[Cytomegalovirus]] - common [[symptoms]] include [[sore throat]], swollen [[lymph nodes]], [[fever]], [[headache]], [[fatigue]], [[weakness]], [[muscle pain]]  and [[loss of appetite]].
| style="background: #DCDCDC; padding: 5px;"|[[Rubella]]
 
|
*[[Scarlet fever]] - commonly includes [[fever]], punctate red [[macules]] on the hard and soft [[palate]] and [[uvula]] ([[Forchheimer's spots]]), bright red [[tongue]] with a "strawberry" appearance, [[sore throat]] and [[headache]] and [[lymphadenopathy]].
* Commonly presents with a facial [[rash]] which then spreads to the [[trunk]] and [[limbs]], fading after 3 days, low grade [[fever]], swollen [[glands]], [[joint pain]]s, [[headache]] and [[conjunctivitis]]. The [[rash]] disappears after a few days with no staining or peeling of the [[skin]]. ''[[Forchheimer's sign]]'' occurs in 20% of cases, and is characterized by small, red [[papules]] on the area of the [[soft palate]].
 
|-
*[[Rocky Mountain spotted fever]] - [[symptoms]] may include [[maculopapular rash]], [[petechial rash]], [[abdominal pain]] and [[joint pain]].
| style="background: #DCDCDC; padding: 5px;"|Atypical [[measles]]
 
|
*[[Stevens-Johnson syndrome]] - [[symptoms]] may include [[fever]], [[sore throat]] and [[fatigue]]. Commonly presents [[ulcers]] and other lesions in the [[mucous membranes]], almost always in the [[mouth]] and lips but also in the genital and anal regions. Those in the mouth are usually extremely painful and reduce the patient's ability to eat or drink. [[Conjunctivitis]] of the eyes occurs in about 30% of children. A [[rash]] of round lesions about an inch across, may arise on the face, trunk, arms and legs, and soles of the feet, but usually not on the scalp.
* The symptoms commonly begin about 7-14 days after infection and present as [[fever]], [[cough]], [[coryza]] and [[conjunctivitis]]. Observation of [[Koplik's spots]] is also a characteristic finding in measles.
 
|-
*[[Varicella-zoster virus]] - commonly starts as a painful [[rash]] on one side of the face or body. The [[rash]] forms blisters that typically scab over in 7-10 days and clears up within 2-4 weeks.
| style="background: #DCDCDC; padding: 5px;"|[[Coxsackievirus]]
 
|
*[[Chickenpox]] - commonly starts with [[conjunctival]] and catarrhal [[symptoms]] and then characteristic spots appearing in two or three waves, mainly on the body and head, rather than the hands, becoming itchy raw pox (small open sores which heal mostly without scarring). Touching the fluid from a [[chickenpox]] blister can also spread the disease.
* The most commonly caused disease is the [[Coxsackie A]] disease, presenting as ''hand, foot and mouth disease''. It may be [[asymptomatic]] or cause mild [[symptoms]], or it may produce [[fever]] and painful [[blisters]] in the mouth ([[herpangina]]), on the palms and fingers of the hand, or on the soles of the feet. There can also be [[blisters]] in the [[throat]] or above the [[tonsils]]. Adults can also be affected. The [[rash]], which can appear several days after high temperature and painful sore throat, can be itchy and painful, especially on the hands/fingers and bottom of feet.
 
|-
*[[Meningococcemia]] - commonly presents with [[rash]], [[petechiae]], [[headache]], [[confusion]], and [[stiff neck]], high [[fever]], mental status changes, [[nausea]] and [[vomiting]].
| style="background: #DCDCDC; padding: 5px;"|[[Acne]]
 
|
*[[Rickettsialpox]] - first [[symptom]] is commonly a bump formed by a mite-bite, eventually resulting in a black, crusty scab. Many of the [[symptoms]] are [[flu]]-like including [[fever]], [[chills]], [[weakness]] and [[muscle pain]] but the most distinctive [[symptom]] is the [[rash]] that breaks out, spanning the person's entire body.
* It is typical of teenagers, usually appears on the [[face]] and upper neck, but the [[chest]], [[human back|back]] and [[shoulder]]s may have [[acne]] as well. The upper [[arm]]s can also have [[acne]], but lesions found there are often [[keratosis pilaris]], not [[acne]]. The typical [[acne]] lesions are [[comedones]] and [[inflammatory]] [[papules]], [[pustules]], and [[nodules]]. Some of the large [[nodules]] were previously called "[[cyst]]s"
 
|-
*[[Meningitis]] - commonly presents with [[headache]], [[nuchal rigidity]], [[fever]], [[petechiae]] and [[altered mental status]].
| style="background: #DCDCDC; padding: 5px;"|[[Syphilis]]  
 
|It commonly presents with gneralized systemic [[symptoms]] such as [[malaise]], [[fatigue]], [[headache]] and [[fever]]. [[Skin]] eruptions may be subtle and [[asymptomatic]] It is classically described as:
*[[Impetigo]] - commonly presents with pimple-like lesions surrounded by [[erythematous]] [[skin]]. Lesions are [[pustules]], filled with [[pus]], which then break down over 4-6 days and form a thick crust. It's often associated with insect bites, cuts, and other forms of [[trauma]] to the [[skin]].
* Non-pruritic bilateral symmetrical mucocutaneous [[rash]]
 
* Non-tender regional [[lymphadenopathy]]
* [[Acne conglobata]] - highly [[inflammatory disease]] presenting with [[comedones]], [[nodules]], [[abscess]]es, and draining [[sinus]] tracts.<ref name="Fitz2">Freedberg, et al. (2003). ''Fitzpatrick's Dermatology in General Medicine''. (6th ed.). Page 685. McGraw-Hill. ISBN 0-07-138076-0.</ref><ref name="Bolognia">{{cite book |author=Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |pages= |isbn=1-4160-2999-0 |oclc= |doi= |accessdate=}}</ref>
* Condylomata lata and
 
* Patchy [[alopecia]].
* [[Acne fulminans]] - also known as acne maligna, is a rare and sudden onset severe form of cystic [[acne]]. It is often accompanied by [[fever]] and [[inflammatory]] [[arthralgia|aching of the joints]]. The sudden flare of [[acne]] fulminans can occur after unsuccessful treatment for another form of [[acne]], [[acne conglobata]].
|-
 
| style="background: #DCDCDC; padding: 5px;"|[[Molluscum contagiosum]]
* [[Neonatal acne]] - (also known as "Acne infantum," "Acne neonatorum",<ref name="pmid11187144">{{cite journal |author=Holm EA, Jemec GB |title=[Acne neonatorum/acne infantum] |language=Danish |journal=Ugeskr. Laeg. |volume=162 |issue=50 |pages=6856–7 |date=December 2000 |pmid=11187144 |doi= |url=}}</ref> and "Neonatal cephalic pustulosis"<ref name="Bolognia">{{cite book |author=Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |pages= |isbn=1-4160-2999-0 |oclc= |doi= |accessdate=}}{{pn|date=March 2012}}</ref> (not to be confused with "Benign cephalic histiocytosis")) is an acneiform eruption that occurs in newborns or infants, and is often seen on the nose and adjacent portions of the cheeks.<ref name="Fitz2">{{cite book |editor1-first=Irwin M. |editor1-last=Freedberg |editor2-first=Arthur Z. |editor2-last=Eisen |editor3-first=Klauss |editor3-last=Wolff |editor4-first=K. Frank |editor4-last=Austen |editor5-first=Lowell A. |editor5-last=Goldsmith |editor6-first=Stephen |editor6-last=Katz |year=2003 |title=Fitzpatrick's Dermatology in General Medicine |edition=6th |publisher=McGraw-Hill |isbn=978-0-07-138076-8 |page=648}}</ref>
|
 
* The lesions are commonly flesh-colored, dome-shaped, and pearly in appearance. They are often 1-5 millimeters in diameter, with a dimpled center. Generally not painful, but they may itch or become irritated. Picking or scratching the lesions may lead to further [[infection]] or scarring. In about 10% of the cases, [[eczema]] develops around the lesions. They may occasionally be complicated by secondary [[bacterial infections]].
* [[Gram-negative]] [[folliculitis]] - [[Folliculitis]] starts when hair follicles are damaged by friction from clothing, blockage of the follicle, or [[shaving]]. In most cases of folliculitis, the damaged follicles are then infected with the [[bacterium|bacteria]] [[Staphylococcus]].
|-
 
| style="background: #DCDCDC; padding: 5px;"|[[Mononucleosis]]
* [[Hidradenitis suppurativa]] - Hidradenitis suppurativa or HS is a [[skin disease]] that affects areas bearing [[apocrine sweat glands]] and hair follicles; such as the underarms, groin and buttocks. It is more commonly found in women and can be present under the breasts.
|
 
* Common [[symptoms]] include low-grade [[fever]] without [[chills]], [[sore throat]], white patches on [[tonsils]] and back of the throat, [[muscle weakness]] and sometime extreme [[fatigue]], tender [[lymphadenopathy]], [[petechial hemorrhage]] and [[skin rash]].
* [[Miliaria]] ("heat rash") - [[skin disease]] marked by small and itchy [[rash]]es. Miliaria is a common ailment in hot and humid conditions, such as in the tropics and during the summer season.  Although it affects people of all ages, it is especially common in children and infants due to their underdeveloped sweat glands.
|-
 
| style="background: #DCDCDC; padding: 5px;"|Toxic [[erythema]]  
* [[Pyoderma faciale]] - disease that causes [[tissue (biology)|tissue]] to become [[necrosis|necrotic]], causing deep [[ulcer]]s that usually occur on the legs.  When they occur, they can lead to [[chronic wound]]s.  Ulcers usually initially look like small bug bites or [[papule]]s, and they progress to larger ulcers.  Though the [[wound]]s rarely lead to death, they can cause [[Pain and nociception|pain]] and [[scar]]ring.
|
 
* It is a common [[rash]] in infants, with clustered and [[vesicular]] appearance.
* [[Rosacea]]
|-
| style="background: #DCDCDC; padding: 5px;"|[[Rat-bite fever]]  
|
* It commonly presents with [[fever]], [[chills]], open sore at the site of the bite and [[rash]], which may show red or purple plaques.
|-
| style="background: #DCDCDC; padding: 5px;"|[[Parvovirus B19]]
|
*The [[rash]] of fifth disease is typically described as "slapped cheeks," with [[erythema]] across the cheeks and sparing the nasolabial folds, forehead, and mouth.
|-
| style="background: #DCDCDC; padding: 5px;"|[[Cytomegalovirus]]
|
* The common [[symptoms]] include [[sore throat]], swollen [[lymph nodes]], [[fever]], [[headache]], [[fatigue]], [[weakness]], [[muscle pain]] and [[loss of appetite]].
|-
| style="background: #DCDCDC; padding: 5px;"|[[Scarlet fever]]  
|
* It commonly includes [[fever]], punctate red [[macules]] on the hard and soft [[palate]] and [[uvula]] ([[Forchheimer's spots]]), bright red [[tongue]] with a "strawberry" appearance, [[sore throat]] and [[headache]] and [[lymphadenopathy]].
|-
| style="background: #DCDCDC; padding: 5px;"|[[Rocky Mountain spotted fever]]  
|
* The [[symptoms]] may include [[maculopapular rash]], [[petechial rash]], [[abdominal pain]] and [[joint pain]].
|-
| style="background: #DCDCDC; padding: 5px;"|[[Stevens-Johnson syndrome]]  
|
* The [[symptoms]] may include [[fever]], [[sore throat]]  and [[fatigue]]. Commonly presents [[ulcers]] and other lesions in the [[mucous membranes]], almost always in the [[mouth]] and lips but also in the genital and anal regions. Those in the mouth are usually extremely painful and reduce the patient's ability to eat or drink. [[Conjunctivitis]] of the eyes occurs in about 30% of children. A [[rash]] of round lesions about an inch across, may arise on the face, trunk, arms and legs, and soles of the feet, but usually not on the scalp.
|-
| style="background: #DCDCDC; padding: 5px;"|[[Varicella-zoster virus]]  
|
* It commonly starts as a painful [[rash]] on one side of the face or body. The [[rash]] forms blisters that typically scab over in 7-10 days and clears up within 2-4 weeks.
|-
| style="background: #DCDCDC; padding: 5px;"|[[Chickenpox]]  
|
* It commonly starts with [[conjunctival]] and catarrhal [[symptoms]] and then characteristic spots appearing in two or three waves, mainly on the body and head, rather than the hands, becoming itchy raw pox (small open sores which heal mostly without scarring). Touching the fluid from a [[chickenpox]] blister can also spread the disease.
|-
| style="background: #DCDCDC; padding: 5px;"|[[Meningococcemia]]
|
* It commonly presents with [[rash]], [[petechiae]], [[headache]], [[confusion]], and [[stiff neck]], high [[fever]], mental status changes, [[nausea]] and [[vomiting]].
|-
| style="background: #DCDCDC; padding: 5px;"|[[Rickettsialpox|Rickettsial pox]]
|
* The first [[symptom]] is commonly a bump formed by a mite-bite, eventually resulting in a black, crusty scab. Many of the [[symptoms]] are [[flu]]-like including [[fever]], [[chills]], [[weakness]] and [[muscle pain]] but the most distinctive [[symptom]] is the [[rash]] that breaks out, spanning the person's entire body.
|-
| style="background: #DCDCDC; padding: 5px;"|[[Meningitis]]  
|
* It commonly presents with [[headache]], [[nuchal rigidity]], [[fever]], [[petechiae]] and [[altered mental status]].
|}


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Latest revision as of 20:14, 29 July 2020

Acne vulgaris Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

Acne vulgaris must be differentiated from other diseases that cause scaly red skin, comedones, papules, nodules, and possibly scarring, including chickenpox, herpes zoster, erythema multiforme, among others.

Differentiating Acne Vulgaris from other Diseases

Different rash-like conditions can be confused with acne and are thus included in its differential diagnosis. The various conditions that should be differentiated from acne include:[1][2][3][4][5][6][7]

Disease Features
Impetigo 
  • It commonly presents with pimple-like lesions surrounded by erythematous skin. Lesions are pustules, filled with pus, which then break down over 4-6 days and form a thick crust. It's often associated with insect bites, cuts, and other forms of trauma to the skin.
Insect bites
  • The insect injects formic acid, which can cause an immediate skin reaction often resulting in a rash and swelling in the injured area, often with formation of vesicles.
Kawasaki disease
Measles
Monkeypox
  • The presentation is similar to smallpox, although it is often a milder form, with fever, headache, myalgia, back pain, swollen lymph nodes, a general feeling of discomfort, and exhaustion. Within 1 to 3 days (sometimes longer) after the appearance of fever, the patient develops a papular rash, often first on the face. The lesions usually develop through several stages before crusting and falling off.
Rubella
Atypical measles
Coxsackievirus
  • The most commonly caused disease is the Coxsackie A disease, presenting as hand, foot and mouth disease. It may be asymptomatic or cause mild symptoms, or it may produce fever and painful blisters in the mouth (herpangina), on the palms and fingers of the hand, or on the soles of the feet. There can also be blisters in the throat or above the tonsils. Adults can also be affected. The rash, which can appear several days after high temperature and painful sore throat, can be itchy and painful, especially on the hands/fingers and bottom of feet.
Acne
Syphilis It commonly presents with gneralized systemic symptoms such as malaise, fatigue, headache and fever. Skin eruptions may be subtle and asymptomatic It is classically described as:
Molluscum contagiosum
  • The lesions are commonly flesh-colored, dome-shaped, and pearly in appearance. They are often 1-5 millimeters in diameter, with a dimpled center. Generally not painful, but they may itch or become irritated. Picking or scratching the lesions may lead to further infection or scarring. In about 10% of the cases, eczema develops around the lesions. They may occasionally be complicated by secondary bacterial infections.
Mononucleosis
Toxic erythema
  • It is a common rash in infants, with clustered and vesicular appearance.
Rat-bite fever
  • It commonly presents with fever, chills, open sore at the site of the bite and rash, which may show red or purple plaques.
Parvovirus B19
  • The rash of fifth disease is typically described as "slapped cheeks," with erythema across the cheeks and sparing the nasolabial folds, forehead, and mouth.
Cytomegalovirus
Scarlet fever
Rocky Mountain spotted fever
Stevens-Johnson syndrome
  • The symptoms may include fever, sore throat and fatigue. Commonly presents ulcers and other lesions in the mucous membranes, almost always in the mouth and lips but also in the genital and anal regions. Those in the mouth are usually extremely painful and reduce the patient's ability to eat or drink. Conjunctivitis of the eyes occurs in about 30% of children. A rash of round lesions about an inch across, may arise on the face, trunk, arms and legs, and soles of the feet, but usually not on the scalp.
Varicella-zoster virus
  • It commonly starts as a painful rash on one side of the face or body. The rash forms blisters that typically scab over in 7-10 days and clears up within 2-4 weeks.
Chickenpox
  • It commonly starts with conjunctival and catarrhal symptoms and then characteristic spots appearing in two or three waves, mainly on the body and head, rather than the hands, becoming itchy raw pox (small open sores which heal mostly without scarring). Touching the fluid from a chickenpox blister can also spread the disease.
Meningococcemia
Rickettsial pox
Meningitis

References

  1. ↑ Hartman-Adams H, Banvard C, Juckett G (2014). "Impetigo: diagnosis and treatment". Am Fam Physician. 90 (4): 229–35. PMID 25250996.
  2. ↑ Mehta N, Chen KK, Kroumpouzos G (2016). "Skin disease in pregnancy: The approach of the obstetric medicine physician". Clin Dermatol. 34 (3): 320–6. doi:10.1016/j.clindermatol.2016.02.003. PMID 27265069.
  3. ↑ Moore, Zack S; Seward, Jane F; Lane, J Michael (2006). "Smallpox". The Lancet. 367 (9508): 425–435. doi:10.1016/S0140-6736(06)68143-9. ISSN 0140-6736.
  4. ↑ Ibrahim F, Khan T, Pujalte GG (2015). "Bacterial Skin Infections". Prim Care. 42 (4): 485–99. doi:10.1016/j.pop.2015.08.001. PMID 26612370.
  5. ↑ Ramoni S, Boneschi V, Cusini M (2016). "Syphilis as "the great imitator": a case of impetiginoid syphiloderm". Int J Dermatol. 55 (3): e162–3. doi:10.1111/ijd.13072. PMID 26566601.
  6. ↑ Kimura U, Yokoyama K, Hiruma M, Kano R, Takamori K, Suga Y (2015). "Tinea faciei caused by Trichophyton mentagrophytes (molecular type Arthroderma benhamiae ) mimics impetigo : a case report and literature review of cases in Japan". Med Mycol J. 56 (1): E1–5. doi:10.3314/mmj.56.E1. PMID 25855021.
  7. ↑ CEDEF (2012). "[Item 87--Mucocutaneous bacterial infections]". Ann Dermatol Venereol. 139 (11 Suppl): A32–9. doi:10.1016/j.annder.2012.01.002. PMID 23176858.

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