How Acne Is Diagnosed: All You Need To Know

You’ve had a few pimples pop up on your face, but how do you know if what you’re experiencing is actually acne? Is it okay for you to diagnose yourself with acne, or do you need to see a dermatologist to get a formal diagnosis? 

Read on to find out all you need to know about diagnosing acne.

Can you self-diagnose your acne?

Acne is a common skin disorder, affecting around 85% of people aged between 12 and 24 years in the US.¹ Not all of those people need to see a specialist to get a diagnosis.

If you have very mild acne, you may be able to diagnose yourself and control your symptoms with over-the-counter treatments. Moderate and severe acne would most likely need to be diagnosed by a doctor as treatment is more aggressive and is often dependent on the clinical features and severity.² Use the following table as a guide to get an indication of the severity of your acne:

Although you may feel confident to make a self-diagnosis of acne, you should see a dermatologist if any of the following apply:

• Your acne changes or gets worse

• Your acne does not respond to over-the-counter medications

• You notice that you are developing acne scars or dark spots

• You are not sure that your diagnosis is correct

• You feel you would benefit from a more personalized treatment plan

If your acne is moderate or severe, you may be at risk of developing scars and dark spots. You need to ensure your treatment is effective and appropriate. The best way to do this is to see a dermatologist for a formal diagnosis and treatment plan.

How will your doctor diagnose acne?

The most important step in diagnosing acne is the clinical examination. Your doctor will likely start by taking a detailed history from you. They may ask you about any family history of acne, what your lifestyle and diet are like, what skin products or treatments you've been using if you’re on any medication and if you have any allergies.

The next step would be to confirm that your pimples have the typical appearance of acne lesions. Typical acne lesions are distributed on the face, jawline, neck, chest, or upper back and can be:

• Whiteheads

• Blackheads

• Papules

• Pustules

• Cysts

• Nodules

If your history and symptoms are typical of acne, you probably won’t need further tests. 

If your lesions have an odd appearance or look as though they may be secondarily infected, your doctor may take a scraping from one of the lesions to send away for investigation. 

If there are any signs that your acne may be due to an underlying medical condition, such as polycystic ovary syndrome, your doctor might do blood tests to confirm or exclude the diagnosis.

During your consultation, your dermatologist may note down what type of lesions you have and where on your face they are. They may also ask your permission to take a photograph of your acne to keep in your patient file. These details on record make it easier to see if your acne is improving after starting treatment.

What could be mistaken for acne?

There are a number of conditions that you could mistake for acne. The treatment for these conditions differs from the treatment of acne. It’s for this reason that it’s a good idea to see your doctor for a proper diagnosis. Some of the conditions that could be mistaken for acne include:

Acne rosacea

Acne rosacea looks similar to acne.³ However, it is much more common in people over the age of 30 and tends to be restricted to the central area of the face (forehead, nose, cheeks, and chin). It is characterized by redness and flushing of the skin, pustules, visible blood vessels beneath the skin’s surface, and thickening of the skin, especially over the nose. 

Hidradenitis suppurativa

Hidradenitis suppurativa presents with lesions that may initially look similar to acne pimples or cysts.⁴ However, they are typically in a different distribution. Hidradenitis suppurativa is usually found where skin touches the skin, such as under the armpits, under the breasts, or between the thighs. Although the lesions initially look similar to acne pimples and cysts, with time, they may develop into significant abscesses. 

Perioral dermatitis

Perioral dermatitis can cause a rash that looks similar to acne, except that it is usually confined to the area around your mouth.⁵ It is possible for you to get a similar red, pustular dermatitis rash around your nose and/or eyes simultaneously. Perioral dermatitis can be caused by an allergy or skin irritation. Sometimes there is a secondary infection, and antibiotics are necessary to clear the rash.

Folliculitis

Folliculitis is an infection of the hair follicle that can look very similar to acne.⁶ It’s usually caused by damage to the hair follicle, which allows germs to enter and cause infection. On the face, it’s often caused by shaving. Folliculitis can resolve on its own if you stop whatever caused the initial damage to the hair follicles. However, it does sometimes require treatment with antibiotics.

The lowdown

Mild acne may be easy to diagnose yourself, however, it could well be worth making an appointment to see a dermatologist for a formal diagnosis.

Diagnosis is generally made simply by looking at your acne bumps and pimples and asking you some questions about your family history, lifestyle, and symptoms. Acne can be mistaken for various other conditions such as acne rosacea, hidradenitis suppurativa, perioral dermatitis, or folliculitis. As the management of these is different from the treatment of acne, it's useful to have a dermatologist make the diagnosis and prescribe treatment.