Not all red spots on the skin are due to acne. Several other skin conditions can lead to rashes and bumps that look like pimples. These include folliculitis, rosacea, milia, keratosis pilaris, allergic reaction, eczema, molluscum contagiosum, and staph infection. Rarely, a non-healing acne-like bump may be skin cancer.
Before discussing the above-mentioned skin conditions in detail, let’s briefly talk about acne.
Acne is a skin condition that can lead to the formation of pimples. Pimples are small bumps that occur due to clogged pores, inflammation, or the proliferation of bacteria.
These bumps can be whiteheads, blackheads, papules (red bumps), pustules (red bumps with pus), or big deeper red bumps called cysts.
They are usually not itchy; however, deeper red bumps can be painful.
Pimples are typically seen in teenagers, young adults, or with hormonal changes.
It is usually treated with topical antibiotics, exfoliants, and retinoids. In some cases, oral antibiotics, hormones, or Accutane may be prescribed.
Below you will find 15 skin conditions that can present with pimple-like rashes (or acne-like bumps).
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1. Folliculitis
Folliculitis can result in red bumps that may be mistaken for pimples. In fact, folliculitis is a common cause of bumps on the legs that look like pimples.
These bumps occur due to inflammation and infection of the hair follicles and can affect any hair-bearing area.
If the infection penetrates deeper into the hair follicle, it can form a boil. Commonly affected areas include the face, arms, legs, and buttocks.
Types and cause
Folliculitis is of several types and the most common type is bacterial folliculitis (often occurs due to Staphylococcus aureus).
Another type of folliculitis called Malassezia folliculitis, occurs due to infection of hair follicles by a fungus called Malassezia. It can present with itchy acne-like bumps usually on the forehead.
As compared to pimples, bumps of folliculitis look the same. Also, pimples are usually not itchy.
Few factors can increase one’s chance of getting folliculitis. These include – skin injury, prolonged antibiotic use, heavy sweating, contaminated hot tubs, and certain medical conditions like diabetes.
Treatment
Mild cases of bacterial folliculitis may resolve on their own. Antibacterial washes may be helpful.
In some cases, topical antibiotics like mupirocin or oral antibiotics may be needed.
Malassezia folliculitis treatment includes washing the area with anti-dandruff shampoo. In some cases, topical or oral antifungals may be needed.
2. Keratosis pilaris
Bumps on arms that look like pimples may be due to keratosis pilaris.
This skin condition leads to tiny, rough, red bumps which may feel like sandpaper. It usually involves the cheeks, upper arms, thighs, and buttocks. These usually do not hurt or itch.
Keratosis pilaris often appears at a young age, affecting children and adolescents, and typically clears up by the age of 20 to 30.
Cause
This occurs due to blockage of the hair follicles with keratin, a protein that is part of the outer layer of our skin. The exact cause of why this happens is not clear.
It may be associated with genetic factors or atopic dermatitis.
It can get worse in cold and dry weather.
Treatment
These bumps clear with age. However, few ingredients can help in improving its appearance. These include exfoliants like – lactic acid, glycolic acid, retinoids (like retinol), and urea.
3. Milia
Ever tried popping small white bumps near your eyes? These pesky white bumps are not acne, but a skin condition called milia.
They can be seen anywhere on the face, especially around the eyes, cheeks, and nose. They are often confused with closed comedones which are a type of acne lesion.
Milia can occur at any age, and they are often seen in small babies as well.
Cause
Milia occur due to trapping dead skin cells under the skin which can harden, resulting in the formation of tiny hard bumps.
There are several factors that are associated with milia. These include:
- Prolonged steroid use.
- Autoimmune conditions.
- Sun exposure.
- Skin damage due to any injury, rash, or harsh skincare products.
- Genetics.
- Heavy skincare products.
- Procedures like laser skin resurfacing and microdermabrasion.
- In infants, the mother’s hormones are thought to play a part.
Treatment
Milia are harmless and usually go away in a few weeks or months. Few ingredients can help in clearing them. It includes exfoliants like salicylic acid and topical retinoids like retinol.
If over-the-counter topicals do not work, your doctor can prescribe retinoids like tretinoin or recommend procedures like chemical peels, laser, or cryotherapy.
Do not try to pop them as that can injure the area leading to infection or scarring.
4. Contact dermatitis
An allergic rash can also look like acne. Contact dermatitis is a rash that develops when the skin comes in contact with an allergen or irritant. It can lead to pimple-like red bumps, dryness, itching, or oozing. In some cases, it may form fluid-filled bumps called blisters.
In contrast to pimples, contact dermatitis can develop suddenly and does not present with various types of lesions as seen in acne. Moreover, unlike contact dermatitis, pimples are usually not itchy and do not form blisters filled with clear fluid.
Types and cause
Contact dermatitis can be divided into two types:
Allergic contact dermatitis occurs as a result of contact with an allergen. The common allergens are poison ivy, latex, metals like nickel, pollen, pet dander, molds, etc.
Irritant contact dermatitis occurs when the skin comes in contact with an irritant that can damage the skin barrier. The common irritants are fragrances, essential oils, dyes, surfactants, etc.
Treatment
- One should avoid further contact with the allergen or irritant.
- Cool compress, antihistamines, and topical steroids may help in managing the symptoms.
5. Heat rash (Miliaria)
Heat rash aka prickly heat can lead to an itchy pimple-like rash. The bumps of heat rash are usually monomorphic, meaning they look the same. They are common in areas covered with clothing.
Heat rash is often seen in babies and young children although it can occur at any age.
Cause
These occur due to the trapping of sweat under the skin in hot climates.
Treatment
It does not require any specific treatment. Cold baths and antihistamines can help in reducing the symptoms.
Wear loose breathable clothing and avoid the use of thick and occlusive skincare products.
6. Ingrown hair
Ingrown hair occurs when hair that was removed by shaving, waxing, or tweezing, starts growing and curves back into the skin. This can irritate the skin and lead to the formation of red or pus-filled bumps.
Cause
This occurs due to the structure of the hair and the direction in which it grows. It is usually seen in people with curly or coarse hair.
Treatment and prevention
One can prevent these by avoiding the removal of hair. If you want to remove hair, avoid close shaving and shave in the direction of the hair. In addition, one can opt for laser hair removal.
At-home treatment of ingrown hair includes stopping hair removal and allowing the hair to grow back, use of exfoliants like salicylic, and retinoids like retinol.
In some cases, your doctor may prescribe a topical antibiotic or steroid.
7. Rosacea
Red spots on the face that are not acne, can be due to rosacea. Rosacea is a chronic inflammatory skin condition that is of 4 different types. Papulopustular rosacea can present with redness, broken capillaries, and red bumps.
In addition, there may be episodes of flushing or blushing in response to emotional stimuli, extremes of temperatures, or certain foods. It may be associated with an itching and burning sensation.
The red bumps (papules and pustules) can be confused with pimples; however, pimples are usually not itchy and are not accompanied by flushing or telangiectasia.
Certain skincare ingredients that may help in improving acne can actually irritate rosacea-prone skin.
Cause
The exact cause is not clear. Genetics, environmental factors, immune system, abnormal vessels, or Demodex mites may play some role in it.
Treatment
It is treated with:
- Topicals like metronidazole, azelaic acid, and ivermectin.
- In some cases, oral antibiotics may be prescribed.
8. Perioral dermatitis
Perioral dermatitis can lead to acne-like red bumps – papules or pustules, around the mouth. They can also appear around the nose and eyes.
They may be associated with itching and burning sensations. perioral dermatitis is commonly seen in females 20-40 years of age.
Cause
The exact reason is not known. It is frequently associated with topical use of steroids, steroid inhalers, toothpaste with fluoride, dental fillings, thick and occlusive skincare products, and hormonal changes.
Treatment
The use of steroids and thick skincare products should be avoided. Your doctor may prescribe topical (metronidazole, erythromycin) or oral antibiotics (like doxycycline, and minocycline).
Read more about perioral dermatitis vs acne here. For more details about perioral dermatitis, refer to this article.
9. Molluscum contagiosum
Molluscum contagiosum is a viral infection that can lead to small white-, pink- or skin-colored bumps on the skin. These bumps have a central depression in them and are shiny or waxy in appearance.
In comparison to pimples, which are commonly seen in teenagers, molluscum contagiosum occurs most commonly in children. It can occur in adults with suppressed immune systems.
It can appear on the face, chest, back, or extremities (also on genitalia in adults).
Cause
It occurs due to a pox virus called Molluscum contagiosum. The virus can spread by direct contact with the bumps or contaminated surfaces. It can also be transferred via sexual contact.
Treatment
Molluscum contagiosum usually doesn’t require treatment. They can take a very long time to disappear (up to 2 years in some cases).
Your doctor may recommend procedures to remove them like laser therapy, curettage, or cryotherapy.
Read more: Molluscum contagiosum stages, pictures and symptoms
10. Sebaceous hyperplasia
Sebaceous hyperplasia can lead to skin-colored, white, or yellowish bumps on the skin. They are commonly seen on the cheeks or forehead and usually do not hurt or itch.
Cause
These occur due to entrapment of sebum in the sebaceous glands leading to their enlargement.
Treatment
They are harmless and do not require treatment. However, they can be treated with topicals and procedures.
- Over-the-counter retinoids may be helpful although prescription-strength retinoids like tretinoin may be more effective in improving them.
- Oral isotretinoin and anti-androgens may help in shrinking these lesions
- In-office procedures may be done to remove them. They may include laser, electrodesiccation, photodynamic therapy, freezing, or excision.
11. Chickenpox
Chickenpox is a viral infection that appears in three phases – the appearance of red bumps, which form blisters, and eventually these scabs.
The new lesions continue to appear so you can see all three phases together. These are often associated with itching.
The rash may be accompanied by fever, fatigue, or headache. The rash is widespread unlike acne, so you can see the involvement of mucosal surfaces, palms, and soles too.
Cause
This occurs due to infection by a type of herpes virus called Varicella-zoster virus. The virus can spread by close contact or contaminated surfaces.
It can be prevented by a chickenpox vaccine.
Treatment
The rash usually clears on its own in 10 days to 2 weeks. In people with weaker immune systems or certain medical conditions, antiviral medication may be prescribed.
12. Atopic dermatitis
Atopic dermatitis is the most common type of eczema. It is often seen in children although it can occur at any age.
It can lead to redness, raised bumps, dry skin, and itching. In some cases, there may be formation of blisters. Constant scratching can lead to secondary bacterial infection.
The symptoms can differ depending on the age.
- In babies, redness and bumps are usually seen on the face, scalp, or limbs.
- In young children, it may involve flexural aspects like the front of the elbow or the back of the knee.
- In adults with chronic disease, it may present with dry skin and thickening.
Cause
The exact cause is not known. It is associated with genetic factors, skin barrier defect, or altered skin microbiome.
Treatment
The treatment will depend on the severity of the disease. For mild cases, gentle skincare, short bath time, and barrier repair moisturizers may be beneficial.
In a few cases, topical steroids, calcineurin inhibitors, or other topicals may be prescribed.
13. Swimmer’s itch (Cercarial dermatitis)
Swimmer’s itch can present with red bumps which look like pimples. They are usually associated with itching.
Cause
This occurs due to an allergic reaction to a parasite. One can get it by swimming in outdoor water bodies infested with parasites, especially freshwater lakes or ponds.
The parasite can burrow into the skin, but since humans are not the primary host, the parasite dies soon. However, the allergic reaction can last longer.
As compared to acne which usually occurs on the face, chest, or back, swimmer’s itch involves the body areas exposed to water. The areas covered with the swimsuit are usually not involved.
Treatment
The bumps usually go away in a week. Over-the-counter antihistamines may be helpful. If the symptoms are severe, your doctor may prescribe medication.
14. Staph infection
Staph infections are often mistaken for acne, as they can present with bumps that may look like pimples. These bumps can be small or large in size. They can be painful, warm to the touch, and may leak fluid or pus.
Infections by staph bacteria commonly result in mild skin conditions. However, sometimes they can penetrate deeper into the tissue, resulting in severe disease.
Cause
Staph infections are often caused by the bacteria Staphylococcus aureus. This bacteria may be found on the skin and mucous membranes, such as in the nostrils.
Although it is usually harmless, it may cause skin infections in some individuals. The risk factors include skin injury, a suppressed immune system, eczema, diabetes, and immune disorders.
Methicillin-resistant Staphylococcus aureus (MRSA) is an antibiotic-resistant form of Staph infection that can be resistant to usual treatments.
Treatment
Treatment of staph infections will depend on the severity of the infection. It may include topical, oral, or intravenous antibiotics. In some cases, surgical treatment may be needed.
Staph infections can be prevented by frequent handwashing, especially when touching injured or broken skin.
15. Skin cancer
Some types of skin cancer bumps can be mistaken for pimples, especially basal cell carcinoma.
Basal cell carcinoma is the most common type of skin cancer which arises from basal cells which form the bottom layer of the epidermis.
It can present as a skin-colored, pink, or red shiny bump. It is a slow-growing tumor, so if you see a pimple-like bump that does not heal, it’s best to get it examined by a doctor.
Cause
It occurs due to DNA damage in the basal cells from UV rays. It is commonly seen in areas exposed to the sun, especially the face, ears, neck, scalp, and trunk.
Treatment
It is usually treated with surgical excision in which the tumor along with healthy tissue surrounding it is removed.
Other treatment options include topicals, freezing, radiation, or curettage.
Key points
Rashes and bumps that look like pimples include keratosis pilaris, heat rash, staph infection, rosacea, perioral dermatitis, contact dermatitis, atopic dermatitis, milia, sebaceous hyperplasia, molluscum contagiosum, folliculitis, swimmer’s itch, and rarely skin cancer.
One should see a doctor if the pimple-like rash involves a large area of the body, does not heal, is painful, accompanied by visible discharge or other symptoms like fever, headache, dizziness, etc.
References
- Sun KL, Chang JM. Special types of folliculitis which should be differentiated from acne. Dermatoendocrinol. 2017 Sep 27;9(1):e1356519. doi: 10.1080/19381980.2017.1356519. PMID: 29484091; PMCID: PMC5821164.
- Badri T, Gandhi GR. Molluscum Contagiosum. [Updated 2022 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
Disclaimer: This blog post is for information purposes only and does not replace medical advice.