Differential Diagnosis of Acne in Younger Pediatric and Adolescent Patients

Adolescent (∼12–18 y of age)
 Corticosteroid-induced acne
 Demodex folliculitis
 Gram-negative folliculitis
 Keratosis pilaris
 Malassezia (pityrosporum) folliculitis
 Papular sarcoidosis
 Perioral dermatitis
 Pseudofolliculitis barbae
 Tinea faciei
Preadolescent (≥7 to ≤12 y of age)
 Acne venenata or pomade acne (from the use of topical oil-based products)
 Angiofibromas or adenoma sebaceum
 Corticosteroid-induced acne
 Flat warts
 Keratosis pilaris
 Molluscum contagiosum
 Perioral dermatitis
Mid-Childhood (1–7 y of age)
 Adrenal tumors
 Congenital adrenal hyperplasia
 Cushing syndrome
 Gonadal tumors
 Ovarian tumors
 Premature adrenarche
 True precocious puberty
Any Age
 Acne venenata or pomade acne (from the use of topical or oil-based products)
 Bilateral nevus comedonicus
 Chlorinated aromatic hydrocarbons (chloracne)
 Corticosteroids (topical, inhaled, and oral)
 Facial angiofibromas (tuberous sclerosis)
 Flat warts
 Infections (bacterial, viral, and fungal)
 Keratosis pilaris
Medication-Induced (anabolic steroids, dactinomycin, gold, isoniazid, lithium, phenytoin, and progestins)
 Molluscum contagiosum
 Periorificial dermatitis
  • Adapted from Tom and Friedlander6 and Krakowski and Eichenfield.7