Acneiform facial eruptions: a problem for young women

Abstract

Objective: To summarize clinical recognition and current management strategies for four types of acneiform facial eruptions common in young women: acne vulgaris, rosacea, folliculitis, and perioral dermatitis.

Quality of evidence: Many randomized controlled trials (level I evidence) have studied treatments for acne vulgaris over the years. Treatment recommendations for rosacea, folliculitis, and perioral dermatitis are based predominantly on comparison and open-label studies (level II evidence) as well as expert opinion and consensus statements (level III evidence).

Main message: Young women with acneiform facial eruptions often present in primary care. Differentiating between morphologically similar conditions is often difficult. Accurate diagnosis is important because treatment approaches are different for each disease.

Conclusion: Careful visual assessment with an appreciation for subtle morphologic differences and associated clinical factors will help with diagnosis of these common acneiform facial eruptions and lead to appropriate management.

Figure 1. Acne vulgaris in various stages

A) Several closed comedones (1-mm to 2-mm pale white, dome-shaped papules); B) Several open comedones, papules with a central orifice filled with a brown-black substance; C) Acne papule; D) Several punched-out depressions marking acne scars.

Figure 2. Rosacea

A young woman has persistent erythema and red papules on both cheeks. No comedones are visible.

Figure 3. Rosacea

Rosacea can persist into later decades. This older woman has deep symmetrical erythema and many red papules on her cheeks, forehead, and chin.

Figure 4. Folliculitis

A cluster of small monomorphic pustules appears on a woman’s forehead.

Figure 5. Perioral dermatitis

Pinpoint erythematous papules, some confluent, are distributed in a perioral array distinctly sparing the vermilion border of the lip.