Are you sure that you have acne? Case#1

(updated 9/26/2020)

This is not acne! The white box covers the patient’s personal info. The circled spot below the white box is the biopsy site.

“Good morning, how can I …(help you)? “I tried to utter my standard greeting to my new patient with acne. Still, I could not finish it. “…Dr. T I tried everything under the sun, and nothing works for my acne. Not even antibiotic pills, Dr. Googledorf (not real name), had put me on for two months! It is so, so depressing!” my new teenage patient, let’s call him Justin, told me in one desperate breath. I was perplexed because, at first glance, he indeed had acne and not that terribly bad acne, but something was odd. Every pimple looked the same, like clones, and there were no blackheads, which are the telltale diagnostic sign of acne. At that moment, everything became clear – Justin does not have acne! He has folliculitis, which is a different ball game from acne. Since standard over-the-counter acne medications and oral antibiotics did not work, the cause couldn’t be any bacteria. It was not hard to convince Justin that we need to do a biopsy to figure out the cause of his “acne” because he was already at the end of his wits because of it. After several days the result came – Pityrosporon (a form of yeast) folliculitis!
Justin cleared his resistant “acne” after a week of using antifungal shampoo and cream.

Bottom line – not everything that looks like acne is acne. Even physicians can misdiagnose them. A good rule of thumb is: “No acne without blackheads.” In general, all over-the-counter acne medicines containing salicylic acid, benzoyl peroxide, or adapalene will clear or at least somewhat improve acne after 6-8 weeks of use. If there is no improvement whatsoever, then you should see your healthcare provider or even a dermatologist for a correct diagnosis.

I’ll cover another interesting and quite common acne look-a-like case in the next post, so look for it in the next week or two.  Please do not hesitate to send me any comments or questions at our host’s email:

Thank you, and take care in these challenging times for everyone!


Dr. T

Viseslav Tonkovic-Capin, MD, FAAD

Dermatologist & Dermatopathologist

Diplomate of American Board of Dermatology

Fellow of the American Academy of Dermatology

Fellow of the American Acne and Rosacea Society

Fellow of the American Society for Dermatologic Surgery

Dermatology Foundation Leaders Society Member

Instagram: Dr. T (@acnedoc)

Dr. T practices in the greater Kansas City metro area and has authored more than twenty articles and book chapters on various skin diseases, including acne, in the top scientific national and international journals. He was also interviewed by multiple national media outlets, including NBC, HuffPost, Men’s Health, and Cosmopolitan, on different topics, including skincare and acne. 

2 responses to “Are you sure that you have acne? Case#1

Hi Mate,

I wish I could help you over the internet, but it is hard to come to a correct diagnosis when I see you in person, let alone like this.
The diagnosis of fungal or yeast folliculitis is challenging even for dermatologists. Therefore I recommend you to see a dermatologist in your community for a good exam and work-up.

I wish you all the best, thank you, and take care in these challenging times for everyone!

Very truly yours,

Dr. T

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