Diagnosis and differential diagnoses
Diagnosis
- Acne vulgaris is often clinically apparent and distinguished by the presence of pleomorphic lesions including comedones.
- The presence of comedones is what distinguishes acne vulgaris from other cutaneous disorders.
Differential Diagnosis
- The most common acne mimics are
- Rosacea
- Perioral dermatitis
- Folliculitis.
Diagnostic Methods
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Acne vulgaris is usually diagnosed clinically by the presence of a pleomorphic collection of lesions including papules and pustules.
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The presence of comedones is required for the clinical diagnosis of acne vulgaris.
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In general, the diagnosis of acne vulgaris does not require laboratory testing. However, a thorough evaluation of a patient presenting with acne should include a complete history to rule out a systemic etiology of disease.
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Rapid onset of acne associated with virilization should prompt laboratory testing of hormonal levels and imaging studies to rule out an underlying adrenal or ovarian tumor.
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Elevated serum androgens are found in patients with severe cystic acne and in association with endocrine abnormalities or neoplastic processes.
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The majority of patients with acne have normal levels of serum androgens.
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Additionally, a complete medication list should be obtained to rule out medication-induced acne.
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Physical examination should focus on the type and location of lesions, scarring, keloids, and postinflammatory pigmentary changes.