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General lnternal Medicine Acneiform Lesions Diagnosis Acne is a chronic inflammatory sl<in condition characterized by open and closed comedones (blackheads and whiteheads, respec tively) and inflan.rmatory papules, pustules, or nodules. Rosacea is a chronic inflammatory skin disorcler that affects the cheeks ancl nose and usually occurs after thc age of 30 years. Rosacea has a variety of clinic:rl presentations, including eryth rotelangiectatic and papulopustular. The papulopustular variant ofrosaceir can be confused with acne. but rostcea does not pre Rosa(ea: Papules, pustules, and dilated blood vessels involving the central face are sent llith comedonal lesions. Telangiectasias ancl flushing are typical of rosacea. Rosacea involves the nasolabial folds, whereas the malar rash of seen in the erythrotelangiectatic subtype. SLE does not. ln early stages, rosacea can resemble the malar rash of SLE. Howevcr, the rash of SLE spares the r.rasolabial fblds. The develop ment of papules, pustules, and flushing is inconsistent with SLE and supports the diagnosis of rosacea.

Rosacea is a chronic inflammatory skin disorcler that affects the cheeks ancl nose and usually occurs after thc age of 30 years. Rosacea has a variety of clinic:rl presentations, including eryth rotelangiectatic and papulopustular. The papulopustular variant ofrosaceir can be confused with acne. but rostcea does not pre Rosa(ea: Papules, pustules, and dilated blood vessels involving the central face are sent llith comedonal lesions. Telangiectasias ancl flushing are typical of rosacea. Rosacea involves the nasolabial folds, whereas the malar rash of seen in the erythrotelangiectatic subtype. SLE does not. ln early stages, rosacea can resemble the malar rash of SLE. Howevcr, the rash of SLE spares the r.rasolabial fblds. The develop ment of papules, pustules, and flushing is inconsistent with SLE and supports the diagnosis of rosacea. STUDY TABLE: Differential Diagnosis of Acne Disease Characteristics Acne (acne vulgaris) Microcomedones are precursors to acne lesions. They are very common in adolescents but also in preadolescents and adults. Women may have premenstrual flare-ups. Physical examination: coexisting open and closed comedones, papules, pustules, and nodular lesions located primarily on the face, neck, and upper trunk Rosacea Not true acne; primary lesion is not a comedone but an inflammatory papule; rhinophyma (bulbous, red nose) is a variant. Physical examination: central facial erythema, telangiectasias, papules, and pustules Bacterial fol liculitis Common in athletes Physical examination: follicular papules; pustules; occasional furuncles on any hair-bearing area, especially scalp, b,uttocks, and thighs. Most common cause is S. aureus. Periorificial dermatitis, idiopathic MoTe common in women

STUDY TABLE: Differential Diagnosis of Acne Disease Characteristics Acne (acne vulgaris) Microcomedones are precursors to acne lesions. They are very common in adolescents but also in preadolescents and adults. Women may have premenstrual flare-ups. Physical examination: coexisting open and closed comedones, papules, pustules, and nodular lesions located primarily on the face, neck, and upper trunk Rosacea Not true acne; primary lesion is not a comedone but an inflammatory papule; rhinophyma (bulbous, red nose) is a variant. Physical examination: central facial erythema, telangiectasias, papules, and pustules Bacterial fol liculitis Common in athletes Physical examination: follicular papules; pustules; occasional furuncles on any hair-bearing area, especially scalp, b,uttocks, and thighs. Most common cause is S. aureus. Periorificial dermatitis, idiopathic MoTe common in women Physical examination: small (<2 mm) papules and pustules around the mouth or eyelids; similar to acne but without comedones Periorificia I dermatitis, iatrogenic Frequent causes are prolonged topical glucocorticoid therapy for atopic dermatitis and ina ppropriate use of these agents to treat acne. Similar in appearance to idiopathic type. Classically spares the skin around the lips. Differentiation is by history. DON'T BE TRICKED . The prominent papules and pustules seen in rosacea are not typical of the maculopapular malar rash seen in SLE . The rash of SLE does not involve the nasolabial folds. Perioral Dermatitis: Discrete papules and pustules on an erythematous base around the mouth, but typically sparing the skin directly around the lips, are char' acteristic of perioral dermatitis. 175