How Acne Is Diagnosed

Many people can diagnose acne on their own, particularly in mild cases; most people recognize the symptoms of this very common skin condition. But while you may be familiar with what an occasional zit looks like, there is actually a wide range of severity. Seeing a dermatologist to formally diagnose acne can be very helpful, as different grades of acne usually require different types of treatments. There are also several other skin conditions that mimic acne, which may need a different approach entirely.

Self-Checks

Acne isn't something you need to do a purposeful check for, like you do skin cancer. Rather, it often makes itself well-known when you simply look in the mirror or take a shower.

Symptoms may include blackheads (comedones), whiteheads (pustules), and sometimes inflamed nodules or cysts. All of these symptoms occur due to blockage of a pore.

Mild acne often doesn't require medical consultation and can be treated at home using over-the-counter products. However, if you are unsure if what you are experiencing is acne, or if your acne seems severe or is changing characteristics, see a dermatologist.

Labs and Tests

Acne is diagnosed by a simple visual inspection by your healthcare provider. There is no test for acne. Rarely, a practitioner may take a swab or scraping of a lesion or pustule for microbiological examination or culture to rule out other sources of infection.

For women, hormone blood tests may be ordered to look for conditions such as pregnancy, excessive prolactin, Cushing syndrome, and high testosterone (an indicator of polycystic ovaries).

Imaging

Imaging is not used in diagnosing acne. But if there are indications of predisposing conditions such as ovarian cysts, ovarian tumor, or adrenal tumor, the healthcare provider may order X-rays, CT scans, or MRI studies.

Differential Diagnoses

Some skin conditions can look remarkably similar to acne, although their causes and treatments are different. If you are unsure, it is always wise to consult a dermatologist. They will consider these options and systematically rule them out during your examination.

Rosacea

Rosacea is sometimes mistakenly referred to as "adult acne," but it is caused by a different mechanism than acne in adults. You may need to see a dermatologist to distinguish these conditions early on.

Rosacea causes red, flushed skin with papules and pustules, especially in the nose and cheek area, and may lead to the classic enlargement and bumpiness of the nose, for which it is best known. It is uncommon before the age of 30 and occurs more often in fair-skinned individuals and women (though it tends to be more severe in men).

Folliculitis

Folliculitis is a condition in which the hair follicle is inflamed and bumps or pustules may result. It is usually caused by bacteria (e.g., strep or staph) and is treated with topical or oral antibiotics.

Keratosis Pilaris

Keratosis pilaris is a rash marked by small, rough, "goose-flesh" like bumps most often found on the upper arms, thighs, and buttocks, and sometimes the face. It commonly occurs at the same time in life when acne is prevalent, and roughly 50% of teens have some degree of the condition.

Miliaria Rubra

Miliaria rubra is a rash characterized by small red bumps on the surface of the skin and is caused by excessive heat exposure. It is also known as heat rash or prickly heat.

Rashes Due to Certain Cancer Drugs

Some targeted therapy drugs for cancer, such as Tarceva (erlotinib), cause a rash that closely resembles acne. People who are taking these medications may frantically try using acne preparations but with no success, since the rash is due to a mechanism unrelated to that of acne.

If you have a rash that looks like acne while going through cancer treatment, talk to your oncologist.

Steroid Acne

Steroid acne, which is caused by taking oral steroids such as prednisone, can mimic true acne.

Acne Grades

When a dermatologist lands on a diagnosis of acne, it is classified into one of four grades. Dermatologists evaluate the types of comedones (blackheads) present, amount of inflammation present, breakout severity, how widespread the acne is, and what areas of the body are affected.

Through this, they will also decide what class of acne a case falls into:

• Non-inflamed acne breakouts have open and closed comedones (blackheads)
• Inflamed acne breakouts have papules, pustules, nodules, and/or cysts

Grades of acne are classified as follows:

• Grade I: The mildest form of acne is referred to as grade I. With grade I acne (mild acne), the skin will display blackheads, whiteheads or milia, and occasionally minor pimples. There is no inflammation (minimal redness, swelling, or tenderness). Grade I acne can usually be cleared with over-the-counter treatments.
• Grade II: Grade II acne is considered moderate acne. A greater number of blackheads and whiteheads are present on the skin than with grade I. Papules and pustules (whiteheads) are more frequently found. Grade II acne may also be treated with over-the-counter products. However, if there is no improvement after six to eight weeks, consult your healthcare provider.
• Grade III: Grade III acne is considered moderate to severe acne. The difference between Grade II and Grade III acne is the amount of inflammation present. Papules and pustules will be more numerous and there will be a greater amount of redness and inflammation found on the skin. Nodules are often present. This type of acne should be evaluated by your dermatologist, as it can be both painful and leave behind scars.
• Grade IV: Grade IV acne is the most severe grade of acne. With grade IV acne the skin will display many pustules, nodules, and cysts. Blackheads and whiteheads are usually numerous. There is pronounced inflammation, and breakouts likely extend to areas other than the face, such as the neck, upper chest, and back. Grade IV acne, also called cystic acne, must be treated by a dermatologist.

A Word From Verywell

A proper diagnosis of acne includes not only a confirmation of the classic findings but a description of the severity of the rash. Determining the severity is important in choosing the best treatment options to improve your comfort and minimize scarring. If you are coping with acne that is grade II or higher, or even if you have mild acne that is not responding to over-the-counter medications, make sure to consult a dermatologist. Fortunately, treatment options are available for even the most severe types of acne.