What is the cause of a pruritic acneiform rash on the face?

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Differential Diagnosis for Itchy Acne Rash on the Face

Single Most Likely Diagnosis

  • Acne vulgaris: This is the most common cause of an itchy acne rash on the face, particularly in adolescents and young adults. The itchiness can be due to the inflammatory nature of the acne lesions.

Other Likely Diagnoses

  • Rosacea: Characterized by inflammation, redness, and acne-like lesions, rosacea can also cause itchiness due to the associated dryness and sensitivity of the skin.
  • Perioral dermatitis: This condition presents with a rash around the mouth, which can be itchy and is often mistaken for acne. It's more common in women and can be triggered by various factors, including cosmetics and hormonal changes.
  • Seborrheic dermatitis: While more commonly associated with a scalp rash, seborrheic dermatitis can also affect the face, causing an itchy, acne-like rash, particularly in oily areas.

Do Not Miss Diagnoses

  • Lupus miliaris disseminatus faciei (LMDF): A rare form of cutaneous lupus that can mimic acne but is crucial to diagnose due to its association with systemic lupus erythematosus and the need for specific treatment.
  • Sarcoidosis: This systemic disease can cause skin lesions that resemble acne, and while rare, missing the diagnosis could lead to delayed treatment of a potentially serious condition.
  • Dermatomyositis: An autoimmune disease characterized by skin and muscle inflammation. The skin manifestations can include an itchy, acne-like rash on the face, making it a critical diagnosis not to miss due to its implications for systemic disease.

Rare Diagnoses

  • Granulomatous rosacea: A variant of rosacea that can cause an itchy, acne-like rash but is distinguished by the presence of granulomas upon histological examination.
  • Demodex folliculitis: Caused by the Demodex mite, this condition can lead to an itchy, acne-like rash, particularly in immunocompromised individuals or those with poor hygiene.
  • Halogen acne: A rare condition caused by exposure to halogens (such as iodine or bromine), leading to an acne-like rash that can be itchy.

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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