Diagnosis Comedones are almost always present, and lesions at various stages of development are seen simultaneously. Differential diagnosis includes rosacea, which does not have comedones, and corticosteroid-induced acneiform lesions, which usually have follicular pustules in the same stage of development and no comedones. Although acne is almost universal, it may embarrass adolescents, who may withdraw, using the acne as an excuse to avoid difficult personal adjustments. Supportive counseling for patients and parents may be needed. Misconceptions about a relationship between acne and diet, athletics, or sex are common and warrant discussion.
Treatment depends on the severity of the lesions.
Although washing lesions several times a day has little effect, the appearance of an oily face often improves. Any good toilet soap may be used. In superficial pustular acne, topical clindamycin or erythromycin alone or with one of the follicular drugs mentioned below is probably most useful. Sunlight causes mild dryness and slight scaling and is usually helpful. However, sunlight is not always available, and its benefit may be difficult to duplicate with a sunlamp.