Acne Vulgaris Differential Diagnoses

1. Dawson AL, Dellavalle RP. Acne vulgaris. BMJ. 2013 May 8. 346:f2634. [QxMD MEDLINE Link].

2. Thiboutot D, Gollnick H, Bettoli V, Dréno B, Kang S, Leyden JJ, et al. New insights into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group. J Am Acad Dermatol. 2009 May. 60(5 Suppl):S1-50. [QxMD MEDLINE Link].

3. Goulden V, McGeown CH, Cunliffe WJ. The familial risk of adult acne: a comparison between first-degree relatives of affected and unaffected individuals. Br J Dermatol. 1999 Aug. 141(2):297-300. [QxMD MEDLINE Link].

4. Kellett SC, Gawkrodger DJ. The psychological and emotional impact of acne and the effect of treatment with isotretinoin. Br J Dermatol. 1999 Feb. 140(2):273-82. [QxMD MEDLINE Link].

5. Kelhälä HL, Fyhrquist N, Palatsi R, et al. Isotretinoin treatment reduces acne lesions but not directly lesional acne inflammation. Exp Dermatol. 2016 Jun. 25 (6):477-8. [QxMD MEDLINE Link]. [Full Text].

6. Saluja SS, Walker ML, Summers EM, Tristani-Firouzi P, Smart DR. Safety of non-ablative fractional laser for acne scars within 1 month after treatment with oral isotretinoin: A randomized split-face controlled trial. Lasers Surg Med. 2017 Dec. 49 (10):886-890. [QxMD MEDLINE Link].

7. Collier CN, Harper JC, Cafardi JA, Cantrell WC, Wang W, Foster KW, et al. The prevalence of acne in adults 20 years and older. J Am Acad Dermatol. 2008 Jan. 58(1):56-9. [QxMD MEDLINE Link].

8. Jeremy AH, Holland DB, Roberts SG, Thomson KF, Cunliffe WJ. Inflammatory events are involved in acne lesion initiation. J Invest Dermatol. 2003 Jul. 121(1):20-7. [QxMD MEDLINE Link].

9. Norris JF, Cunliffe WJ. A histological and immunocytochemical study of early acne lesions. Br J Dermatol. 1988 May. 118(5):651-9. [QxMD MEDLINE Link].

10. Kim J, Ochoa MT, Krutzik SR, et al. Activation of toll-like receptor 2 in acne triggers inflammatory cytokine responses. J Immunol. 2002 Aug 1. 169(3):1535-41. [QxMD MEDLINE Link].

11. Webster GF. Inflammatory acne represents hypersensitivity to Propionibacterium acnes. Dermatology. 1998. 196(1):80-1. [QxMD MEDLINE Link].

12. Pochi PE, Strauss JS. Sebaceous gland activity in black skin. Dermatol Clin. 1988 Jul. 6(3):349-51. [QxMD MEDLINE Link].

13. Lucky AW, Biro FM, Simbartl LA, Morrison JA, Sorg NW. Predictors of severity of acne vulgaris in young adolescent girls: results of a five-year longitudinal study. J Pediatr. 1997 Jan. 130(1):30-9. [QxMD MEDLINE Link].

14. Baek JH, Ahn SM, Choi KM, Jung MK, Shin MK, Koh JS. Analysis of comedone, sebum and porphyrin on the face and body for comedogenicity assay. Skin Res Technol. 2016 May. 22 (2):164-9. [QxMD MEDLINE Link].

15. Trivedi NR, Cong Z, Nelson AM, Albert AJ, Rosamilia LL, Sivarajah S, et al. Peroxisome proliferator-activated receptors increase human sebum production. J Invest Dermatol. 2006 Sep. 126(9):2002-9. [QxMD MEDLINE Link].

16. Smith TM, Cong Z, Gilliland KL, Clawson GA, Thiboutot DM. Insulin-like growth factor-1 induces lipid production in human SEB-1 sebocytes via sterol response element-binding protein-1. J Invest Dermatol. 2006 Jun. 126(6):1226-32. [QxMD MEDLINE Link].

17. Zouboulis CC, Böhm M. Neuroendocrine regulation of sebocytes -- a pathogenetic link between stress and acne. Exp Dermatol. 2004. 13 Suppl 4:31-5. [QxMD MEDLINE Link].

18. Davis EC, Callender VD. A review of acne in ethnic skin: pathogenesis, clinical manifestations, and management strategies. J Clin Aesthet Dermatol. 2010 Apr. 3(4):24-38. [QxMD MEDLINE Link]. [Full Text].

19. Momin SB, Peterson A, Del Rosso JQ. A status report on drug-associated acne and acneiform eruptions. J Drugs Dermatol. 2010 Jun. 9(6):627-36. [QxMD MEDLINE Link].

20. Mango D, Ricci S, Manna P, Miggiano GA, Serra GB. Clinical and hormonal effects of ethinylestradiol combined with gestodene and desogestrel in young women with acne vulgaris. Contraception. 1996 Mar. 53(3):163-70. [QxMD MEDLINE Link].

21. Basler RS. Acne mechanica in athletes. Cutis. 1992 Aug. 50(2):125-8. [QxMD MEDLINE Link].

22. American Academy of Dermatology. Skin conditions by the numbers. www.aad.org. Available at https://www.aad.org/media/stats/conditions/skin-conditions-by-the-numbers. Accessed: March 26, 2019.

23. Smith RN, Mann NJ, Braue A, Makelainen H, Varigos GA. The effect of a high-protein, low glycemic-load diet versus a conventional, high glycemic-load diet on biochemical parameters associated with acne vulgaris: a randomized, investigator-masked, controlled trial. J Am Acad Dermatol. 2007 Aug. 57(2):247-56. [QxMD MEDLINE Link].

24. Shaw JC, White LE. Persistent acne in adult women. Arch Dermatol. 2001 Sep. 137(9):1252-3. [QxMD MEDLINE Link].

25. [Guideline] Eichenfield LF, Krakowski AC, Piggott C, Del Rosso J, Baldwin H, Friedlander SF, et al. Evidence-based recommendations for the diagnosis and treatment of pediatric acne. Pediatrics. 2013 May. 131 Suppl 3:S163-86. [QxMD MEDLINE Link].

26. Kligman AM. Postadolescent acne in women. Cutis. 1991 Jul. 48(1):75-7. [QxMD MEDLINE Link].

27. Barnes LE, Levender MM, Fleischer AB Jr, Feldman SR. Quality of life measures for acne patients. Dermatol Clin. 2012 Apr. 30(2):293-300, ix. [QxMD MEDLINE Link].

28. Ugge H, Udumyan R, Carlsson J, Andrén O, Montgomery S, Davidsson S, et al. Acne in late adolescence and risk of prostate cancer. Int J Cancer. 2017 Dec 4. [QxMD MEDLINE Link].

29. Mulcahy N. Teen Acne Tied to Prostate Cancer Risk. Medscape News & Perspective. Available at https://www.medscape.com/viewarticle/890102#vp_1. December 14, 2017; Accessed: December 15, 2017.

30. Sutcliffe S, Giovannucci E, Isaacs WB, Willett WC, Platz EA. Acne and risk of prostate cancer. Int J Cancer. 2007 Dec 15. 121 (12):2688-92. [QxMD MEDLINE Link].

31. Housman E, Reynolds RV. Polycystic ovary syndrome: a review for dermatologists: Part I. Diagnosis and manifestations. J Am Acad Dermatol. 2014 Nov. 71 (5):847.e1-847.e10; quiz 857-8. [QxMD MEDLINE Link].

32. Schmidt TH, Khanijow K, Cedars MI, Huddleston H, Pasch L, Wang ET, et al. Cutaneous Findings and Systemic Associations in Women With Polycystic Ovary Syndrome. JAMA Dermatol. 2016 Apr. 152 (4):391-8. [QxMD MEDLINE Link].

33. [Guideline] Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, Berson DS, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016 May. 74 (5):945-973.e33. [QxMD MEDLINE Link].

34. Cunliffe WJ, Holland DB, Jeremy A. Comedone formation: etiology, clinical presentation, and treatment. Clin Dermatol. 2004 Sep-Oct. 22(5):367-74. [QxMD MEDLINE Link].

35. Gollnick H, Cunliffe W, Berson D, Dreno B, Finlay A, Leyden JJ, et al. Management of acne: a report from a Global Alliance to Improve Outcomes in Acne. J Am Acad Dermatol. 2003 Jul. 49(1 Suppl):S1-37. [QxMD MEDLINE Link].

36. Thielitz A, Gollnick H. Topical retinoids in acne vulgaris: update on efficacy and safety. Am J Clin Dermatol. 2008. 9(6):369-81. [QxMD MEDLINE Link].

37. Zaenglein AL. Topical retinoids in the treatment of acne vulgaris. Semin Cutan Med Surg. 2008 Sep. 27(3):177-82. [QxMD MEDLINE Link].

38. Eichenfield LF, Lain T, Frankel EH, Jones TM, Chang-Lin JE, Berk DR, et al. Efficacy and Safety of Once-Daily Dapsone Gel, 7.5% for Treatment of Adolescents and Adults With Acne Vulgaris: Second of Two Identically Designed, Large, Multicenter, Randomized, Vehicle-Controlled Trials. J Drugs Dermatol. 2016 Aug 1. 15 (8):962-9. [QxMD MEDLINE Link].

39. Raoof TJ, Hooper D, Moore A, Zaiac M, Sullivan T, Kircik L, et al. Efficacy and Safety of a Novel Topical Minocycline Foam for the Treatment of Moderate-to-Severe Acne Vulgaris: A Phase 3 Study. J Am Acad Dermatol. 2019 Jun 1. [QxMD MEDLINE Link]. [Full Text].

40. Gold LS, Dhawan S, Weiss J, Draelos ZD, Ellman H, Stuart IA. A novel topical minocycline foam for the treatment of moderate-to-severe acne vulgaris: Results of 2 randomized, double-blind, phase 3 studies. J Am Acad Dermatol. 2019 Jan. 80 (1):168-177. [QxMD MEDLINE Link].

41. Cunliffe WJ, Holland KT. The effect of benzoyl peroxide on acne. Acta Derm Venereol. 1981. 61(3):267-9. [QxMD MEDLINE Link].

42. Hebert A, Thiboutot D, Stein Gold L, Cartwright M, Gerloni M, Fragasso E, et al. Efficacy and Safety of Topical Clascoterone Cream, 1%, for Treatment in Patients With Facial Acne: Two Phase 3 Randomized Clinical Trials. JAMA Dermatol. 2020 Apr 22. [QxMD MEDLINE Link]. [Full Text].

43. Moore A, Green LJ, Bruce S, Sadick N, Tschen E, Werschler P, et al. Once-Daily Oral Sarecycline 1.5 mg/kg/day Is Effective for Moderate to Severe Acne Vulgaris: Results from Two Identically Designed, Phase 3, Randomized, Double-Blind Clinical Trials. J Drugs Dermatol. 2018 Sep 1. 17 (9):987-996. [QxMD MEDLINE Link].

44. Eady EA, Jones CE, Gardner KJ, Taylor JP, Cove JH, Cunliffe WJ. Tetracycline-resistant propionibacteria from acne patients are cross-resistant to doxycycline, but sensitive to minocycline. Br J Dermatol. 1993 May. 128(5):556-60. [QxMD MEDLINE Link].

45. Toossi P, Farshchian M, Malekzad F, Mohtasham N, Kimyai-Asadi A. Subantimicrobial-dose doxycycline in the treatment of moderate facial acne. J Drugs Dermatol. 2008 Dec. 7(12):1149-52. [QxMD MEDLINE Link].

46. Moore A, Ling M, Bucko A, Manna V, Rueda MJ. Efficacy and Safety of Subantimicrobial Dose, Modified-Release Doxycycline 40 mg Versus Doxycycline 100 mg Versus Placebo for the treatment of Inflammatory Lesions in Moderate and Severe Acne: A Randomized, Double-Blinded, Controlled Study. J Drugs Dermatol. 2015 Jun. 14 (6):581-6. [QxMD MEDLINE Link].

47. Valentín S, Morales A, Sánchez JL, Rivera A. Safety and efficacy of doxycycline in the treatment of rosacea. Clin Cosmet Investig Dermatol. 2009 Aug 12. 2:129-40. [QxMD MEDLINE Link].

48. Miller YW, Eady EA, Lacey RW, Cove JH, Joanes DN, Cunliffe WJ. Sequential antibiotic therapy for acne promotes the carriage of resistant staphylococci on the skin of contacts. J Antimicrob Chemother. 1996 Nov. 38(5):829-37. [QxMD MEDLINE Link].

49. Fanelli M, Kupperman E, Lautenbach E, Edelstein PH, Margolis DJ. Antibiotics, Acne, and Staphylococcus aureus Colonization. Arch Dermatol. 2011 Aug. 147(8):917-21. [QxMD MEDLINE Link].

50. Bottomley WW, Cunliffe WJ. Oral trimethoprim as a third-line antibiotic in the management of acne vulgaris. Dermatology. 1993. 187(3):193-6. [QxMD MEDLINE Link].

51. Fernandez-Obregon AC. Azithromycin for the treatment of acne. Int J Dermatol. 2000 Jan. 39(1):45-50. [QxMD MEDLINE Link].

52. Koulianos GT. Treatment of acne with oral contraceptives: criteria for pill selection. Cutis. 2000 Oct. 66(4):281-6. [QxMD MEDLINE Link].

53. Shaw JC. Low-dose adjunctive spironolactone in the treatment of acne in women: a retrospective analysis of 85 consecutively treated patients. J Am Acad Dermatol. 2000 Sep. 43(3):498-502. [QxMD MEDLINE Link].

54. Charny JW, Choi JK, James WD. Spironolactone for the treatment of acne in women, a retrospective study of 110 patients. Int J Womens Dermatol. 2017 Jun. 3 (2):111-115. [QxMD MEDLINE Link].

55. Grandhi R, Alikhan A. Spironolactone for the Treatment of Acne: A 4-Year Retrospective Study. Dermatology. 2017. 233 (2-3):141-144. [QxMD MEDLINE Link].

56. Plovanich M, Weng QY, Mostaghimi A. Low Usefulness of Potassium Monitoring Among Healthy Young Women Taking Spironolactone for Acne. JAMA Dermatol. 2015 Sep. 151 (9):941-4. [QxMD MEDLINE Link].

57. Trivedi MK, Shinkai K, Murase JE. A Review of hormone-based therapies to treat adult acne vulgaris in women. Int J Womens Dermatol. 2017 Mar. 3 (1):44-52. [QxMD MEDLINE Link].

58. Ward A, Brogden RN, Heel RC, Speight TM, Avery GS. Isotretinoin. A review of its pharmacological properties and therapeutic efficacy in acne and other skin disorders. Drugs. 1984 Jul. 28(1):6-37. [QxMD MEDLINE Link].

59. Lee JW, Yoo KH, Park KY, Han TY, Li K, Seo SJ, et al. Effectiveness of Conventional, Low-dose and Intermittent Oral Isotretinoin in the Treatment of Acne: A Randomized, Controlled Comparative study. Br J Dermatol. 2010 Nov 29. [QxMD MEDLINE Link].

60. White GM, Chen W, Yao J, Wolde-Tsadik G. Recurrence rates after the first course of isotretinoin. Arch Dermatol. 1998 Mar. 134(3):376-8. [QxMD MEDLINE Link].

61. Huang YC, Cheng YC. Isotretinoin treatment for acne and risk of depression: A systematic review and meta-analysis. J Am Acad Dermatol. 2017 Jun. 76 (6):1068-1076.e9. [QxMD MEDLINE Link].

62. Bremner JD, Shearer KD, McCaffery PJ. Retinoic acid and affective disorders: the evidence for an association. J Clin Psychiatry. 2012 Jan. 73 (1):37-50. [QxMD MEDLINE Link].

63. Suarez B, Serrano A, Cova Y, Baptista T. Isotretinoin was not associated with depression or anxiety: A twelve-week study. World J Psychiatry. 2016 Mar 22. 6 (1):136-42. [QxMD MEDLINE Link].

64. Crockett SD, Gulati A, Sandler RS, Kappelman MD. A causal association between isotretinoin and inflammatory bowel disease has yet to be established. Am J Gastroenterol. 2009 Oct. 104 (10):2387-93. [QxMD MEDLINE Link].

65. Alhusayen RO, Juurlink DN, Mamdani MM, Morrow RL, Shear NH, Dormuth CR, et al. Isotretinoin use and the risk of inflammatory bowel disease: a population-based cohort study. J Invest Dermatol. 2013 Apr. 133 (4):907-12. [QxMD MEDLINE Link].

66. Rashtak S, Khaleghi S, Pittelkow MR, Larson JJ, Lahr BD, Murray JA. Isotretinoin exposure and risk of inflammatory bowel disease. JAMA Dermatol. 2014 Dec. 150 (12):1322-6. [QxMD MEDLINE Link].

67. Etminan M, Bird ST, Delaney JA, Bressler B, Brophy JM. Isotretinoin and risk for inflammatory bowel disease: a nested case-control study and meta-analysis of published and unpublished data. JAMA Dermatol. 2013 Feb. 149 (2):216-20. [QxMD MEDLINE Link].

68. Crockett SD, Porter CQ, Martin CF, Sandler RS, Kappelman MD. Isotretinoin use and the risk of inflammatory bowel disease: a case-control study. Am J Gastroenterol. 2010 Sep. 105 (9):1986-93. [QxMD MEDLINE Link].

69. Lee SY, Jamal MM, Nguyen ET, Bechtold ML, Nguyen DL. Does exposure to isotretinoin increase the risk for the development of inflammatory bowel disease? A meta-analysis. Eur J Gastroenterol Hepatol. 2016 Feb. 28 (2):210-6. [QxMD MEDLINE Link].

70. Bagatin E, dos Santos Guadanhim LR, Yarak S, Kamamoto CS, de Almeida FA. Dermabrasion for acne scars during treatment with oral isotretinoin. Dermatol Surg. 2010 Apr. 36(4):483-9. [QxMD MEDLINE Link].

71. Barbaric J, Abbott R, Posadzki P, Car M, Gunn LH, Layton AM, et al. Light therapies for acne. Cochrane Database Syst Rev. 2016 Sep 27. 9:CD007917. [QxMD MEDLINE Link].

72. Boen M, Brownell J, Patel P, Tsoukas MM. The Role of Photodynamic Therapy in Acne: An Evidence-Based Review. Am J Clin Dermatol. 2017 Jun. 18 (3):311-321. [QxMD MEDLINE Link].

73. Keyal U, Bhatta AK, Wang XL. Photodynamic therapy for the treatment of different severity of acne: A systematic review. Photodiagnosis Photodyn Ther. 2016 Jun. 14:191-9. [QxMD MEDLINE Link].

74. Wiznia LE, Stevenson ML, Nagler AR. Laser treatments of active acne. Lasers Med Sci. 2017 Aug 4. [QxMD MEDLINE Link].

75. Fulton JE Jr, Plewig G, Kligman AM. Effect of chocolate on acne vulgaris. JAMA. 1969 Dec 15. 210(11):2071-4. [QxMD MEDLINE Link].

76. LaRosa CL, Quach KA, Koons K, Kunselman AR, Zhu J, Thiboutot DM, et al. Consumption of dairy in teenagers with and without acne. J Am Acad Dermatol. 2016 Aug. 75 (2):318-22. [QxMD MEDLINE Link].

77. Di Landro A, Cazzaniga S, Parazzini F, Ingordo V, Cusano F, Atzori L, et al. Family history, body mass index, selected dietary factors, menstrual history, and risk of moderate to severe acne in adolescents and young adults. J Am Acad Dermatol. 2012 Dec. 67 (6):1129-35. [QxMD MEDLINE Link].

78. [Guideline] American Academy of Dermatology. Ten Things Physicians and Patients Should Question. Choosing Wisely. April 30, 2016. Available at http://www.choosingwisely.org/societies/american-academy-of-dermatology/. August 19, 2015;

79. [Guideline] Asai Y, Baibergenova A, Dutil M, Humphrey S, Hull P, Lynde C, et al. Management of acne: Canadian clinical practice guideline. CMAJ. 2015 Nov 16. [QxMD MEDLINE Link]. [Full Text].

80. Harding A. Canadian dermatologists issue new acne treatment guidelines. Reuters Health Information. Available at http://www.medscape.com/viewarticle/854601. November 18, 2015; Accessed: December 11, 2015.

81. FDA safety alert. Over-The-Counter Topical Acne Products: Drug Safety Communication - Rare But Serious Hypersensitivity Reactions. U.S. Food and Drug Administration. Available at http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm402722.htm. Accessed: June 30, 2014.

Jaggi Rao, MD, FRCPC Clinical Professor of Medicine, Division of Dermatology and Cutaneous Sciences, Director of Dermatology Residency Program, University of Alberta Faculty of Medicine and Dentistry, Canada

Jaggi Rao, MD, FRCPC is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, Canadian Dermatology Association, Canadian Medical Association, Canadian Medical Protective Association, Pacific Dermatologic Association, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Jennifer Chen, MD Department of Family and Community Medicine, University of Toronto Faculty of Medicine, Canada

Disclosure: Nothing to disclose.

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Joshua A Zeichner, MD Assistant Professor, Director of Cosmetic and Clinical Research, Mount Sinai School of Medicine; Chief of Dermatology, Institute for Family Health at North General

Joshua A Zeichner, MD is a member of the following medical societies: American Academy of Dermatology, National Psoriasis Foundation

Disclosure: Received consulting fee from Valeant for consulting; Received grant/research funds from Medicis for other; Received consulting fee from Galderma for consulting; Received consulting fee from Promius for consulting; Received consulting fee from Pharmaderm for consulting; Received consulting fee from Onset for consulting.

• Print this section
• Print the entire contents of
• Print the entire contents of article