Signs Your Acne Might Not Actually Be Acne

by Courtney Leiva

Managing pimples and zits can be a huge pain in anyone's backside. And, to make matters even more confusing, even if think we know all the ins-and-outs of the skin we’re in, sometimes those obnoxious breakouts might actually be a totally different skin condition. Yep, sometimes "acne" just isn't acne.

Pimples can be caused by a variety of factors, but breakouts are usually influenced from external and internal factors such as environment, diet, and hormone levels. And while it’s true that these same factors play a big part in our overall skin health, other lesser known factors like allergies, medication side effects, and even vitamin deficiencies can cause conditions that look like acne, but aren’t exactly.

“Acne not really being acne happens quite often,” Celeste Hilling, skincare expert and CEO of Skin Authority, tells me over email. Especially, she says, when you're talking about adult-onset acne.

To take out of the confusion of what’s actually acne and what’s not, I talked to some skincare experts about pimples that aren't really pimples. Here are five major skin issues you could be confusing for acne. If you suspect you may have any of the conditions below, make an appointment with your dermatologist to find the best treatment plan for you.

1. Rosacea

Commonly mistaken for acne, rosacea is a skin condition that causes pus-filled bumps in the central part of the face. But unlike acne, which generally features whiteheads and blackheads on your face and back, rosacea is often associated with facial redness and painful bloodshot eyes.

“Acne rosacea may be confused with acne vulgaris,” explains board-certified dermatologist and RealSelf contributor Dr. Heidi Waldorf via email. “Rosacea consists of central facial redness, dilated blood vessels, and flushing."

And while both acne and rosacea have a genetic link, acne is usually caused by hormonal stimulation and bacteria. On the other hand, rosacea is usually triggered by extreme temperatures, diet changes, and stress.

“Rosacea is often hereditary and there are definite trigger factors which may include spicy foods, extreme temperatures, and stress,” adds Dr. Waldorf. “There is no cure, but you can keep it under control.”

2. Allergic Reactions

Allergic reactions can come in many shapes and forms, so it’s really no surprise that some skin irritations can mimic acne breakouts. However, the key difference between acne and allergic skin reactions is usually intense itching, which comes with red, scaly patches. And yes it's true that acne can be painful, but usually it doesn’t itch.

“An allergic reaction consists of red, scaly itchy patches,” explains Debra Jaliman, board-certified NYC dermatologist and author of Skin Rules: Trade Secrets From a Top New York Dermatologist via email. “An allergic reaction tends to itch, while acne doesn't. Acne can actually be painful, especially if you have large cysts.” If you're constantly having allergic reactions, start keeping a food and product diary to try to narrow down what could be causing your skin to freak.

3. Acneiform Eruptions

Hair products in particular, can cause acneiform eruptions (often looking like fine red bumps) which appear on the forehead area. These annoying reactions are sort of a cross between acne and an allergic reactions, but should be treated more like the latter.

“Hair products with oils cause forehead acneiform eruptions,” says Dr. Neal Schultz, NYC dermatologist, host of and creator of BeautyRx by Dr. Schultz through email. “Oil containing products always aren’t appropriate for some skin types." If bumps are showing on your scalp, try switching shampoo, conditioner, and other hair products you're using.

4. Chloracne

While rashes and redness can be annoying, it's most important to keep an eye out for "acne" that's actually a chronic skin disease. Chloracne for example, can cause pustules, blackheads and cysts, which definitely resembles your typical sort of acne.

“Chloracne is caused by exposure to dioxin (environmental pollutants), and usually looks like acne,” says Dr. Debra Jaliman. “It usually occurs on the face, arms and groin, and occur from direct skin contact or by inhalation.”

5. Basal Cell Carcinoma

Scarily, basal cell carcinoma often resembles simple pimples. This skin cancer is the biggest reason to keep a close eye on any chronic acne.

“Basal cell carcinoma can be mistaken for a pimple,” says Dr. Heidi Waldorf. “This common skin cancer is prevalent on the face, and appears as a shiny or pearly red bump that can bleed and scab. However, the big difference between the two is that acne cysts usually don’t last for several months.” If you have a big pimple that's been around for months, it's best to see a dermatologist ASAP for testing.

Understanding breakouts can be a difficult task, so if you have any skin abnormalities that are leaving you extremely confused, your best course of action is always to seek the help of a dermatologist. Doing so can help you properly pinpoint all your symptoms, and receive the best diagnosis and treatment plan possible.

"If the condition is not getting better, is noticeably getting worse, or just keeps coming back, see your dermatologist," says Dr. Heidi Waldorf. "Be sure to bring in a list of what products you have been using, and for how long the symptoms have occurred." Most of the time, it's probably acne — but it never hurts to double check.

Images: Alia Wilhem, Manu Camargo, Daria Nepriakhina, Neill Kumar, Francisco Moreno, Drew Hays/Unsplash