Diagnosis of Cystic Acne

Physical Examination

This article was Medically reviewed by A. Michael, MD

Diagnosis of cystic acne is done through a detailed physical examination conducted by a qualified health care professional.

The diagnostic process for cystic acne may also include microbiological testing (in cases where there is suspicion of the involvement of gram-negative bacteria) and endocrinology testing to evaluate for contributing factors like hormonal imbalances.
Acne may be mild, moderate or severe and the location of the lesions is generally on the face, back and chest. It is known that a typical acne presentation has both open and closed comedones (blackheads as well as whiteheads), the presence of inflammatory lesions in the form of papules and pustules, scarring, excessive secretion of sebum and post-inflammatory pigmentation.
Pilosebaceous units are found in every location of the body with the exception of the palms, soles, and the top area of our feet, as well as the lower part of the lip. The density of these units is higher on the face, chest, and upper neck, and this is why acne breakouts usually take place in these locations.

Microbiological Testing

The usual bacterium involved in the clinical presentation of acne is a gram-positive bacterium which is part of the normal skin bacteria. In some cases, gram-negative folliculitis that presents with pustules and/or nodules is seen mostly located on the perioral and nasal areas.
This type of acne is due to a number of bacteria and does not respond to traditionally used antibiotics in acne treatment. In such cases, there may be the need for microbiological testing in the form of bacterial cultures and carrying out antibacterial sensitivity tests that can be valuable in making a clear diagnosis and choosing a suitable treatment option.

Endocrinological Evaluation

Under normal circumstances, routine endocrinologic evaluation (such as the testing for excess levels of androgens) is not recommended for most patients with acne. This sort of laboratory assessment is suggested for those patients that do show acne with some symptoms indicating androgen excess.
For young children, this issue is seen in the form of bad body odor, presence of axillary or pubic hair, as well as clitoromegaly. Adult females showing the signs of hyperandrogenism sometimes also manifest with a recalcitrant or late onset of cystic acne together with irregular menstruation cycles, presence of male or female pattern alopecia (balding), infertility as well as truncal obesity.

Conditions Mistaken For Cystic Acne

It is already proven that a majority of acne outbreaks are pleomorphic in nature and present with a range of lesions such as comedones, papules, pustules, nodules, as well as pitted and hypertrophic scarring. A major factor accounting for unresponsiveness in such patients may be the possible misdiagnosis of any conditions mimicking acne. Acne is sometimes misdiagnosed and confused with many other diseases.
When a patient does not show any good response even though a good and efficient treatment protocol is given by the doctor, and the patient follows it properly, the patient might be suffering from a condition that is often mistaken for cystic acne. Conditions that could be mistaken for acne vary, including Folliculitis, Miliaria, Syringoma, and Sabaceous Hyperplasia.

Who Can Be Affected

Acne is known to be the most common skin disorder on a global scale. It has happened to 90% of the world’s population at some stage in their lifetime. Although epidemiologic studies show that acne can occur at any age, it usually shows up during puberty and continues to get progressively worse in adolescence.
Puberty and middle age: Acne has been found to mostly occur in people whose age falls between puberty and 30 years. Within this range, 79 to 95% of the people fall in the 16 to 18 years age group, while more than 81% of the patients fall in the puberty to 30 years age group.
Children: Acne has also been documented in young children, wherein 2 to 61% of affected children fall in the 10 years to 12 years age group. However, this skin disorder has also been documented in young children that fall in the four years to seven years age group.

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