Ever look at an unfamiliar spot or blemish and wonder if it's a blackhead, pimple, or sun spot? Worse, ever consider that it could be something more? To the untrained eye, unusual skin presentations can cause confusion and alarm. They can also go misdiagnosed, often not getting the attention they require. This is because many skin conditions can seem similar in appearance to one another, says Shari Marchbein, board-certified dermatologist and clinical assistant professor of dermatology at New York University School of Medicine.
"For example, a pink flaky spot or rash can be eczema, dandruff, ringworm, psoriasis, or even a skin cancer, like squamous cell carcinoma," she says. Unfortunately, patients sometimes report to the dermatologist's office sharing a previous diagnosis that is incorrect and having missed out on valuable treatment time. Because this occurs more often than documented, we've highlighted the top six skin conditions most commonly mistaken — and how to look out for them.
Basal Cell Carcinoma
In some cases, skin cancer can be mistaken as a small blemish. Basal cell carcinoma (the most common skin cancer in the U.S. – one in five people will have it in their lifetime, according to the Skin Cancer Foundation) "can appear as non-healing pimples or crusty spots that don't seem to clear up," says Orit Markowitz, a board-certified dermatologist in New York City. Markowitz utilizes a dermatoscope, a handheld device that combines light and microscope technology, to properly diagnose early basal cell carcinoma and other skin diseases.
Because skin cancer can be so easy to overlook with the naked eye, dermatologists typically recommend coming into the office for examinations if a new spot is present for more than three weeks and is consistently growing, bleeding, or changing in any way.
Perioral Dermatitis
Perioral dermatitis, a facial rash that typically shows up around the mouth, is often mistaken for acne, says Corey L. Hartman, a board-certified dermatologist in Birmingham, Alabama. Similar to some acne breakouts, the rash presents as red, scaly bumps but as Hartman explains, patients it may actually be a reaction to longtime use of a corticosteroid medication. "To treat it, patients must stop using all corticosteroids, including hydrocortisone cream or a prescription corticosteroid," he says.
Hartman recommends heading to your dermatologist if you have persistent irritation around the mouth area. Your doctor can prescribe an antibiotic to clear up the rash and help you curate a gentle skin-care routine to alleviate the irritation.
Rosacea
"Many people think rosacea equates to bright red, irritated skin," says Hartman. But rosacea can look less red on darker skin, or appear similar to acne. According to Estee Williams, a board-certified dermatologist and clinical professor in dermatology at Mount Sinai Medical Center in New York City, the lack of understanding and awareness surrounding rosacea often leads to misdiagnoses. "Pimples, breakouts, zits... everyone knows what acne is, but many people have not heard of rosacea, even though 16 million Americans have the condition," she says.
Out of those millions of people, not all rosacea cases look the same; the condition may present itself in many various forms. "There are 50 shades of red — anything from rosy cheeks to pimples that are often mistaken as acne," says Williams. "Even the most seasoned dermatologist may find it challenging to distinguish the two, and what's more, acne medications tend to make rosacea worse."
Williams warns that if you have sensitive skin, tend to blush or flush easily, or have pink pimples that take a long time to heal, you might have rosacea. But a proper diagnosis is key to treatment, as a misdiagnosis could potentially exacerbate the condition.
"It's important to diagnose rosacea properly because its treatments are quite different than treatments for acne or seborrheic dermatitis," says Hartman. "Using an acne treatment on rosacea skin could actually be quite uncomfortable for a rosacea patient and make the rosacea worse."
Psoriasis
Many people self-diagnose themselves with a dry, flaky scalp when, in fact, they have psoriasis, according to Joshua Zeichner, the director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City. "Psoriasis is a condition in which your immune system gets angry at your skin and attacks it," he explains. "We don't understand why this happens."
In this case, the skin typically develops flaky plaques, which typically show up on the elbows and knees, but can also be found on the scalp. Dermatologists can suggest prescription options to help with inflammation.
Hyperpigmentation
Melasma is actually a form of hyperpigmentation, which is a broad skin condition in which skin has discolored or darkened for a variety of reasons, such as sun damage or acne scarring. Though it presents similarly, with dark spots on the face, melasma is its own specific condition, which often appears during pregnancy. "People think they have melasma when they really have sun damage," says Ellen Marmur, a board-certified dermatologist in New York City.
Despite their close relationship, "these skin concerns need very different treatments," says Marmur. "Melasma needs a very light hand in treatment; if you do too strong of treatment, you can make it much worse." Whereas, on the other hand, "sun damage can be treated with a very strong laser in order to renew the skin," adds Marmur.
Traditional hyperpigmentation will likely respond to over-the-counter brightening products along with in-office treatments like lasers and peels, while the severity of your melasma (and the opinion of a dermatologist) should be a consideration in determining the best course of action.
Eczema
Eczema — an inflammatory condition in which the skin develops microscopic cracks, causing a loss of hydration — is an especially sneaky condition. Most dermatologists we surveyed call out eczema as a common misdiagnosis, and its potential mistaken identities are numerous.
"Eczema presents as a rash that itches," says Hartman. "It actually begins with a feeling on the skin oftentimes before the actual rash develops, so some patients might think they have a bug bite or some other itch." That "bug bite" may actually be eczema, which shows up in one of 10 Americans, and can affect patients of any age.
According Marmur, eczema is also often confused for acne. "Patients start buying products like benzoyl peroxide, chemical peels, or scrubs and they're basically drying out their skin, when the correct diagnosis might be a form of eczema or rosacea," she says.
Eczema might even masquerade as ringworm, a fungal infection. "Many people come into the office having used an antifungal cream on a scaly, red rash on the body," says Zeichner. "I find that more times than not patients are actually suffering from eczema."
Why play "Is it ringworm or acne?" yourself when you could let an expert tell you for sure? With so many potential pitfalls, it's important to seek expert insight and treatment from a board-certified dermatologist any time you have an unusual skin finding or concern. As Marmur points out, "it's important that you see a doctor because different skin issues have very different treatments." A proper diagnosis is the first step to a resolution.
For more advice from dermatologists:
- How to Remove Skin Tags, According to Dermatologists
- 13 Top Dermatologists Reveal Their Skin-Care Routines
- 25 Black Dermatologists to Follow
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