What Causes a Rash Like Acne on the Face?

Reviewed on 10/11/2022
A teenager with a red rash on her face
Skin conditions that can cause a rash that looks like acne on the face include rosacea, keratosis pilaris, eczema (atopic dermatitis), folliculitis, hives, milia, perioral dermatitis, and hidradenitis suppurativa (HS).

Skin rashes are abnormal changes in skin color, texture, or appearance. Some rashes on the face may look like acne, but are not. It is important to see a dermatologist for the correct diagnosis and treatment.  

Eight skin conditions that can cause a rash that looks like acne on the face include: 

  • Rosacea
    • Starts with blushing or flushing easily, and redness can spread beyond the nose and cheeks to forehead and chin and may come and go or be permanent
    • Acne-like breakouts appear where there is redness on the face
  • Keratosis pilaris
    • Tiny bumps that are plugs of dead skin cells and feel rough occur on the skin that may look like pimples, goosebumps, or the skin of a plucked chicken
    • Appears on cheeks more frequently in children
  • Eczema (atopic dermatitis)
    • Skin conditions that cause itchy, red, inflamed, scaly skin
  • Folliculitis
    • Infected hair follicles
  • Hives
    • Red, itchy welts 
    • Usually caused by allergies
  • Milia
    • Small, harmless cysts containing keratin that look like tiny pearly-white bumps just under the surface of the skin
  • Perioral dermatitis
  • Hidradenitis suppurativa (HS)
    • Can look like pimples and acne cysts
    • Often occurs parts of the body where skin touches skin like in the armpits or inner thighs, but in rare cases, it can develop on the face

What Are Symptoms of a Rash Like Acne on the Face?

Symptoms of rashes that look like acne on the face depend on the condition. 

Symptoms of rosacea may include:

  • Blushing or flushing easily
  • Skin redness
  • Visible blood vessels
  • Swelling
  • Acne-like breakouts
  • Skin thickens and has a bumpy texture
  • Sensitive skin that may sting or burn

Symptoms of keratosis pilaris may include tiny bumps on the skin that may:

  • Look like pimples
  • Feel rough and dry like sandpaper
  • Resemble goosebumps or the skin of a plucked chicken
  • Become more noticeable in winter or a dry climate
  • Itch
  • Appear in different colors, including the same color as your skin, white, red, pinkish purple, and brownish black 

Symptoms of eczema (atopic dermatitis) may include:

  • Plugged hair follicles causing small bumps, usually on the face, upper arms, and thighs
  • Intense skin itching 
  • Patches of inflamed skin/skin swelling
  • Skin flaking 
  • Scaly, rough patches of skin
  • Dry skin
  • Sensitive skin
  • Skin discoloration (especially red or pink)

Symptoms of folliculitis may include:

  • Small red bumps that appear like pimples, some with white heads on them
  • May be painful or tender, itchy, and can appear in groups
  • Blisters that may open, ooze, and crust over
  • Large areas of red, swollen skin that may leak pus

Symptoms of hives may include:

  • Slightly raised, pink, or red welts (wheals)
  • Itching (may be severe)
  • Skin swelling 

Symptoms of milia may include:

  • Small pearly white to yellow cysts on skin
  • Bumps painless
  • May be itchy

Symptoms of perioral dermatitis may include:

  • Small, red, acne-like breakouts in people with light-colored skin and skin-colored breakouts in people with skin of color
  • Itching or burning 
  • Dry, flaky skin where the rash occurs

Symptoms of hidradenitis suppurativa (HS) may include:

  • Before the appearance of the lumps
    • Skin discomfort 
    • Swelling 
    • Burning sensation 
    • Itching
    • Sweating excessively
  • Appearance of lumps
    • Breakouts on the skin that look like pimples or boils
    • Tender, deep nodule(s) that can grow and join together
    • Nodules fill with fluid and become painful (abscesses)
    • When abscesses open, blood and pus can spill out with a foul odor
    • Black bumps that resemble blackheads may occur
  • Abscesses heal slowly (if at all) and come back
    • Scars form

SLIDESHOW

Rosacea, Acne, Shingles, Covid-19 Rashes: Common Adult Skin Diseases See Slideshow

How Is a Rash Like Acne on the Face Diagnosed?

The cause of skin rashes like acne on the face is diagnosed with a history and physical examination of the skin. 

Tests may be used to determine the type of rash and/or the cause: 

What Is the Treatment for a Rash Like Acne on the Face?

Treatment for skin rashes that look like acne on the face varies depending on the underlying condition that causes it. 

There is no cure for rosacea but it can be managed. Treatment for skin rashes that look like acne on the face caused by rosacea may include: 

  • Learn what triggers rosacea flares and avoid them 
  • Protect skin from the sun 
  • Use mild skin care products and treat skin gently 

There is no cure for keratosis pilaris, but the condition is harmless and does not require treatment unless it itches or the appearance is bothersome. In some cases, it will go away on its own even without treatment. Treatment for skin rashes that look like acne on the face caused by keratosis pilaris may include: 

  • Creamy moisturizer to soothe itch and dryness with ingredients such as urea and lactic acid
  • Exfoliating to diminish the bumpy appearance
  • Laser or light treatment if other treatments do not work

Eczema (atopic dermatitis) cannot be cured but it may be managed with home care and medications. Treatment for skin rashes that look like acne on the face caused by eczema may include:

  • Identifying and eliminating triggers 
  • Keeping the skin hydrated
  • Wet dressings (wet wraps) may be used to help soothe and hydrate skin, reduce itching and redness, loosen crusted areas, and prevent skin injury due to scratching
  • Medications such as steroids, antihistamines, “biologics,” or immunosuppressive drugs 
  • Ultraviolet light therapy (phototherapy)

Treatment for skin rashes that look like acne on the face caused by folliculitis may include:

  • Topical medications: antibiotics, steroid creams, or lotions
  • Oral medications: antihistamines, antibiotics, isotretinoin 

Hives usually go away on their own in less than 24 hours. When treatment for skin rashes that look like acne on the face caused by hives is needed, it may include:

  • Antihistamines 
  • Corticosteroids (short-term use)
  • Severe cases of hives or angioedema may require an injection of epinephrine (EpiPen or shot of adrenaline)

Milia are harmless and does not require treatment unless it itches or the appearance is bothersome. In some cases, it will clear on their own even without treatment. Treatment for skin rashes that look like acne on the face caused by milia should be performed by a doctor and may include: 

  • De-roofing with a sterile needle or blade and squeezing or pricking out
  • Diathermy and curettage, or cryotherapy
  • Topical retinoids 
  • The antibiotic minocycline 

Treatment for skin rashes that look like acne on the face caused by perioral dermatitis may include: 

  • Stop applying all corticosteroids, including hydrocortisone cream, to the skin
    • If applying over-the-counter products without a doctor’s knowledge, stop
    • If applying a prescription product, talk to your doctor before stopping
  • Antibiotics, such as tetracycline or erythromycin
  • Changes to skin care routine such as switching to mild or fragrance-free products

Hidradenitis suppurativa (HS) cannot be cured but it can be controlled to reduce symptoms. Treatment for skin rashes that look like on the face caused by hidradenitis suppurativa may include:

  • A skin care plan
  • Medication, an in-office procedure, or both 
  • Treatment for infection 
  • Wound care
  • Pain control
  • Treatment for depression or anxiety that may result from feelings about the condition

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Reviewed on 10/11/2022
References
REFERENCES:

Image source: iStock Images

https://www.aad.org/public/diseases/

https://nationaleczema.org/

https://www.dermnetnz.org/topics/