What is Acneiform Eruptions?
Acneiform eruptions are conditions that look like common acne, usually showing as small bumps (papules) and pus-filled bumps (pustules). Telling these conditions apart from general acne can be tricky, particularly in a doctor’s office, as these eruptions can also show as lumps (nodules) and sacs filled with fluid (cysts) like regular acne. However, there are several key differences.
Unlike acne, the blockages or plugs known as comedones are not common in acneiform eruptions, although they can show up in certain versions of these conditions. Additionally, these eruptions often come on suddenly, can affect people at any age, and the skin issues are typically similar in size and spread beyond the areas most prone to oil production, which is different from acne. These conditions can happen due to various reasons, including medications, hormonal changes, reactions to drugs, or genetic issues.
Diagnosis of acneiform eruptions is usually based on a physical examination. However, if it is not clear, a skin sample or a sample of any discharge may be tested. Another way to diagnose it is to stop using the suspected medication and see if the condition improves.
The way to treat acneiform eruptions depends on what is causing them. Unfortunately, many healthcare professionals mistakenly treat these conditions thinking they are dealing with acne, which can make the problem worse.
What Causes Acneiform Eruptions?
Acne-like rashes can occur due to different reasons such as infections, hormonal or metabolic changes, genetic conditions, reactions to certain medications or substances, contact with chemicals, or due to friction or pressure. These causes can irritate the skin’s hair follicles and lead to inflammation.
Specific situations that can lead to these acne-like rashes include exposure to a certain type of chemicals known as halogenated aromatic hydrocarbons, and intake of certain antibiotics like macrolides and penicillin. Certain medications like nystatin, isoniazid, corticotropin, naproxen, and hydroxychloroquine can also trigger these rashes.
Additionally, several types of bacteria or infections, such as Proteus, Klebsiella, Escherichia coli, and Enterobacter infections, can also cause acne-like rashes. One particular yeast infection, called Pityrosporum folliculitis by Malassezia furfur, may also result in itchy rashes on the chest and upper arms.
Other infections that can cause these rashes include Secondary Syphilis, fungal infections, a condition called cutaneous coccidioidomycosis, and an infection by a fungus called Sporothrix schenckii.
Risk Factors and Frequency for Acneiform Eruptions
Acneiform eruptions, a type of skin disorder, can affect anyone at any age, regardless of gender. It’s particularly common among people exposed to bacteria, those using antibiotics, and in patients staying in hospitals. A significant number of patients who are being treated with drugs called epidermal growth factor receptor inhibitors, often used for serious cancers, also develop this condition. According to reports, 60% to 80% of these patients experience acneiform eruptions as a side effect from these drugs.
Signs and Symptoms of Acneiform Eruptions
Acneiform eruptions are diagnosed mostly through physical examination. These are characterized by small, raised bumps and pus-filled spots mainly on the trunk and back, although uncommonly, large, painful lumps can also appear. Unlike regular acne, these eruptions can occur in other areas apart from the face. The cause might be a medication; if that’s the case, the patient would typically observe that the skin clears up once they stop taking the drug.
- Presence of small, inflamed bumps and pus-filled spots
- Lesions are mainly located on the trunk and back
- Rare instances of large, painful lumps
- Can occur on parts of the body other than the face
- Condition may improve upon discontinuation of a specific medication
Testing for Acneiform Eruptions
Acne-like skin conditions or “acneiform eruptions” can be told apart from typical acne, also known as acne vulgaris, by several distinct characteristics. These include a sudden start, uniform look of the skin bumps, the ability for it to show up at any age, and more often affecting the body rather than the face. Unlike common acne, these conditions don’t always occur in oily areas of the skin, and they rarely result in cysts or deep, painful bumps.
Doctors mainly diagnose this condition by examining the skin, but sometimes they might need to take a small sample of the skin (biopsy) or test any fluid from the bumps for further confirmation. Another way to identify these conditions is by stopping the use of a suspected medication and observing if there is an improvement in the symptoms.
Treatment Options for Acneiform Eruptions
The treatment for acne-like skin conditions depends completely on what’s causing them. If bacteria or medications are to blame, stopping exposure to these substances is the first step. To avoid acne caused by physical contact or friction, such as occupational acne, try to minimize these triggers. Improving working conditions or wearing protective clothing could also be beneficial.
Traditional acne treatments often don’t work for these types of skin conditions, but using skin cleaners like salicylic acid or benzoyl peroxide to reduce oiliness might help. Many patients struggle with itching, which antihistamines can help alleviate. For nighttime itching, certain antihistamines also help you sleep.
Retinoids – a type of medication that reduces oil production and quickly clears skin eruptions – has become a popular treatment option. These come in both oral and topical forms. But, retinoids can harm unborn babies, so they shouldn’t be given to women who could become pregnant. Under certain circumstances, medications like dapsone or doxycycline could help, especially if a type of immune cell called eosinophils is involved, or if bacteria are causing skin lesions.
If the acne-like skin condition is due to medications that inhibit a protein called EGFR, oral antibiotics from the tetracycline family are the best preventive treatment. These should be started right when therapy begins, along with a full skincare routine that includes moisturizers and keeping away from irritants. Topical antifungal creams like ciclopirox, econazole, and ketoconazole can help with acne caused by fungal infections. However, treating skin conditions caused by chloracne can be challenging since they might persist for years, even without continued exposure. In some cases, taking the pain reliever indomethacin or the medication cyclosporine might be an effective treatment.
What else can Acneiform Eruptions be?
Acne-like skin eruptions can sometimes be symptoms of different skin conditions. Recognizing the unique features of these outbreaks can lead to a correct diagnosis.
- Demodicosis, for example, can present in four distinct forms, each looking similar to another skin condition such as acne, rosacea, or dermatitis.
- Milia are small white bumps common on newborns’ cheeks and noses, disappearing after a few months.
- Rosacea, although it looks like acne, does not show blackheads or excessive oiliness. It is a recurring condition that affects the face symmetrically and also involves additional symptoms like stinging, burning, swelling, and dryness.
Another condition, Steatocystoma multiplex, is characterized by non-inflammatory, closed bumps on the central chest and back. Eruptive vellus hair cysts can become inflammatory, and they include numerous fine hairs, visible under microscopic examination. Perioral dermatitis is recognized by numerous small bumps and redness around the mouth.
Hidradenitis suppurativa causes painful bumps and abscesses that can lead to sinus tracts and scars. Pseudofolliculitis barbae, resulting from shaving or plucking hair, creates red bumps and pus-filled lesions mostly on men’s facial and neck regions.
Eruptive syringoma may look like acne but can be identified through a specific examination under the microscope. Certain ailiases like angiofibromas, trichoepitheliomas, and eosinophilic pustular folliculitis often show up as numerous face bumps. This last condition is not infection-related but still involves inflammation.
Sarcoidosis is connected to many skin conditions which do not present blackheads or pus-filled bumps like acne, and can be distinguished from it by their location, the lack of skin texture changes, and their consistent appearance.
Periorificial granulomatous dermatitis (PGD) shows up as small bumps, usually symptom-free. Its location sets it apart from perioral dermatitis and from acne. Bacterial folliculitis causes small pus-filled lesions that later turn crusty, accompanied by itching and discomfort.
Gram-negative folliculitis should be considered in acne patients whose condition worsens during antibiotic treatment. Malassezia folliculitis causes a papulopustular outbreak on the face, torso, and upper extremities. Hot tub folliculitis begins from follicular macules to pustules and papules over time.
Secondary syphilis can create crusted bumps, pus-filled bumps, and nodules on various body parts. Sebaceous hyperplasia shows lobulated, yellowish bumps mostly on the forehead and cheekbones. Obsessions-created scratches and self-induced dermatitis mainly occur on the face, chest, and back and can imitate acne.
What to expect with Acneiform Eruptions
Typically, patients get better within a few weeks. However, for any healing wounds or remaining issues, there are several treatment options. These can include laser treatment, removal surgery, topical or oral antibiotics, stopping medication usage, or applying topical or oral retinoids.
Possible Complications When Diagnosed with Acneiform Eruptions
Acneiform eruptions or breakout-like rashes can lead to several complications. These complications can have both physical and emotional consequences. Here are some of the problems that could occur as a result of these rashes:
- Mental stress due to the appearance of the skin
- Discomfort from itchiness
- Additional bacterial infection
- Dark spots left after inflammation
- Scarring, which is uncommon
- Formation of raised scar tissue, known as Keloid
Preventing Acneiform Eruptions
People should be advised that acne-like skin rashes are temporary conditions that look like acne and can be caused by many different factors. These include infections, reactions to medicines, hormone or metabolic imbalances, or inherited health conditions. Keeping a journal of symptoms or getting rid of potential causes might help identify the real cause of these rashes. Also, it’s important not to scratch these rashes to avoid leaving scars or causing keloid, which is an overgrowth of scar tissue.
