Not all skin conditions are as they seem. While some may be obvious to the untrained eye…others can be reason for much more concern and attention.
Common skin conditions like acne and rosacea, different viral rashes, and even poison oak versus poison ivy can all be confused for one another—and some are worse than others.
To help us correctly identify these commonly mistaken skin conditions is our own Marlise Fletter, CNP.
As a board certified family nurse practitioner, Marlise began her career in family practice in 1997 with St. Joseph Medical Group in Fort Wayne, Indiana. She enjoyed 10 years building a firm foundation in family medicine while obtaining additional training in dermatology.
Marlise’s interests include cosmetic dermatology and general adult and pediatric dermatology, particularly skin cancer prevention, diagnosis and treatment of common skin ailments we’ll touch on in this blog post, including eczema, psoriasis, and acne.
Acne vs. Rosacea
Acne Vulgaris and Acne Rosacea are two common skin conditions that resemble each other and can affect adults.
Marlise Fletter explains, “It’s easy to mistake one for the other. However, they’re treated very differently and therefore, in order to get rid of them, you have to diagnose them correctly.”
What do acne and rosacea look like?
Both acne and rosacea are characterized by inflammation, papules and pustules (skin bumps). Acne occurs when hair follicles and skin pores become clogged with oil, dead skin and environmental debris.
What is acne?
Additionally, acne usually presents with comedones, either open (blackheads) or closed (whiteheads). Acne may cause scarring if left untreated. The causes of acne can be genetic or familial, hormonal, or bacterial, and it often presents heavily on the forehead, cheeks, and jawline. The chest and back may also be affected.
What is rosacea?
Rosacea differs from acne because inflammation, intense reddening of the skin, is the predominating symptom. The redness is caused by the dilation of superficial blood vessels in the face. There may still be papules and pustules, however, comedones are not present with rosacea.
Dry skin and itching are more common with rosacea. Also, rosacea usually presents over the central face (forehead, medial cheeks, nose, and chin). Specific triggers like sunlight, heat, alcohol, caffeine, spicy foods, and strong emotions have been identified, which cause rosacea to flare. Controlling exposure to these triggers can improve the symptoms.
“Rosacea does not typically affect the chest or back. However, it can affect the eyes, causing burning, redness, itching, and a gritty feeling or a stye.”
How are acne and rosacea treated?
Now that you’ve identified these skin conditions correctly, they must be treated uniquely, as they can’t always be treated the same way.
There are some treatments that will work with both acne and rosacea. However, some acne treatments will make rosacea worse. It’s important to see your dermatology provider to determine the best regimen for your condition.
Sources: Stanford Medicine, stanfordmedicine25.stanford.edu, National rosacea Society, rosacea.org
Viral Rashes
Viral rashes are skin conditions which result from infections instead of allergic reactions or other stimuli.
What does a viral rash look like?
Viral rashes may be specific to certain viruses like Herpes Simplex, Shingles, or Measles and have a characteristic rash. Nonspecific viral rashes can occur with upper respiratory viruses or flu.
Marlise Fletter says, “Nonspecific viral rashes are flat or slightly raised red rashes that range from faint pink to bright red. What is notable about viral rashes is that they blanch (become white) with pressure.”
How do you know if it’s a viral rash?
A method that determines a viral rash from others is called the glass test. It’s a quick test that can help determine whether a rash is viral.
“To do a glass test, press a clear glass against the rash. With gentle pressure, if the redness disappears and the skin looks white through the bottom of the glass, then the rash is likely viral. No specific treatment is needed for a viral rash. This rash will resolve on its own when the body’s immune system clears the virus.”
Source: Baby Medical Questions and Answers, Baby-Medical-Questions-and-Answers.com, DermIS.net
Poison Ivy Rash vs. Poison Oak Rash
With spring gardening season just around the corner, it’s important to be mindful of rashes that occur with exposure to certain plants. Unlike viral skin rashes, poison Ivy, poison oak, and poison sumac contain a substance called urushiol that triggers an allergic reaction when it comes into contact with the skin.
What do poison ivy and poison oak rashes look like?
The resulting rash is red, itchy, often vesicular (blistering) and may have a linear pattern. Regardless of which of these poison plants a person is exposed to, the rash is the same, because the allergen (urushiol) is the same. Typically, poison ivy is found east of the Rocky Mountains, poison oak grows west of the Rocky Mountains and poison sumac is more common in the southeastern United States or in wet, wooded areas in the northeastern United States.
Poison Oak has been found in some eastern states however, it is very rarely found in the midwestern states. Poison ivy and poison oak both have three leaves and poison sumac has 7-13 leaves. Approximately 75% of people are sensitive to urushiol.
How do you treat poison ivy and poison oak rashes?
Treating poison ivy and poison oak depends on the location and severity of the rash and may include topical and oral antihistamines, topical and oral corticosteroids, and even antibiotics if infection develops from scratching this intensely itchy rash.
Marlise Fletter says, “Long sleeves should be worn when doing yard work, gardening, or working with mulch. There are soaps that do a good job of removing the urushiol from the body and can prevent or lessen the outbreak if used immediately after exposure.”
Sources: Cleveland Clinic, myclevelandclinic.org, Healthwise, healthwise.org, Rash from poison ivy, poison oak or poison sumac, American Academy of Dermatology, aad.com
Stress Rashes
The body can react adversely to an increase in stress. This can result in a stress rash that may look like other skin conditions to the untrained eye.
What does a stress rash look like?
“A stress rash usually takes the form of hives. Hives are red, raised bumps (wheals) that can look like mosquito bites.”
They can range in size from small, less than a centimeter, to several centimeters. Hives usually start in one area but can go away in that area and turn up in others.
A single hive usually goes away within 24 hours. However, new hives form as old ones resolve, which means your rash will come and go. There are many things that can cause hives, including viral infection, illness, or environmental triggers.
Stress is considered an environmental trigger.
How does stress give you a rash?
When a person is stressed, the body releases extra chemicals which change how the body responds to various functions. These changes can cause inflammation, sensitivity, and itching to the skin.
The best treatments for a stress rash include antihistamines and topical cortisone creams. These reduce inflammation and control itching. Meditation and deep breathing exercises can be effective ways to reduce stress as well.
Acne Versus Skin Cancer
Skin cancer can be difficult to identify from home. Because the appearance of acne can vary and skin cancers take on different forms on the skin, it’s easy to mistake one for the other.
With something as serious as cancer, it’s important to get this right.
Can skin cancer look like acne?
“Any pimple-like lesion in an adult that doesn’t resolve or improve within 4 weeks should be evaluated by a dermatology provider.”
In the example below, the lesion on the left is an acne cyst. It looks very similar to the lesion on the right, which is a basal cell skin cancer, but they are very different and one is far more dangerous than the other.
At-home diagnoses are difficult for those who aren’t sure what skin conditions present as what. When skin conditions arise, it’s always best to check with a board-certified dermatologist in order to ensure the best treatment plan.
