Eczema vs. Acne: How to Tell the Difference

Eczema and acne are two very different skin conditions that can sometimes look alike and even occur at the same time on the back, shoulders, and other parts of the body.

Despite similarities in their appearance, their causes are very different. Eczema is considered an atopic condition characterized by an abnormal immune response. Acne occurs when hair follicles become blocked with skin oils and dead skin cells.

This article compares eczema vs. acne and explains how to tell one from the other. It also describes how eczema and acne are treated and if there are treatments that can help both.

Causes of Eczema and Acne

Eczema, also known as atopic dermatitis, causes dry, flaky, scaly skin with redness and itching. The cause of eczema is unknown, but it is largely regarded as a form of atopy along with asthma, hay fever (allergic rhinitis), and food allergies. Atopy refers to an abnormal immune response that causes a hypersensitive reaction.

Eczema can affect people of any age but typically starts early in life. Genetics are thought to play a role. Stress can also contribute to flare-ups.

Acne, on the other hand, is a skin condition that causes bumps when hair follicles become clogged with oil, dead skin, and bacteria. Acne is most common among teenagers during puberty as a result of fluctuating hormones but can persist into adulthood. Unlike eczema, acne is not itchy.

Acne is also common during menstrual cycles as a result of normal hormonal fluctuations. Genetics are also thought to predispose some people to acne.

How Do You Tell if It's Acne or Eczema?

Eczema and acne can sometimes be hard to tell apart, especially if they occur on the neck, upper shoulders, or back.

What Eczema Looks Like

Eczema causes itchy, red patches on the face or body. Redness and itching are the main symptoms of eczema along with dryness, flaking, and scaling.  Affected areas of the skin may turn darker and become infected if scratched.

Eczema most commonly affects the backs of the knees, the insides of elbows, and the back of the neck. The palms and soles may also be affected along with the back, upper shoulders, and buttocks. Eczema rarely affects the face.

What Acne Looks Like

Acne produces pimples from clogged pores. Acne pimples are small, raised bumps that are reddish and swollen, often with a white center.

Acne can appear anywhere you have oil-producing sebaceous glands, most especially the back, shoulders, face, forehead, and chest. Acne is not the result of poor hygiene.

Acne is typically not painful. The one exception is nodulocystic acne which causes larger, swollen, and painful nodules and cysts under the skin.

Ways to Diagnose and Treat Eczema and Acne

Both eczema and acne can be diagnosed and treated by a skin specialist known as a dermatologist. While the treatment approaches are different, there is some overlap in the medications used for both.

Diagnosis and Treatment of Eczema

Eczema is diagnosed by a dermatologist based on a physical examination of the skin and a review of your personal and family history. A skin biopsy, which involves the removal of a small sample of skin, can help confirm a diagnosis and rule out other possible causes.

Eczema cannot be cured, but treatments like moisturizing the skin help reduce symptoms. Topical steroids, Eucrisa (crisaborole ointment), Elidel (pimecrolimus cream), or coal tar can help reduce pain, redness, and itching. Stress management may also help reduce flare-ups.

Diagnosis and Treatment of Acne

Acne is also diagnosed by a dermatologist based on the physical appearance of the skin. Risk factors include puberty, menstruation, medications, and a family history of acne.

Acne treatment includes gentle skin care and the daily use of a light moisturizer. Benzoyl peroxide and oral or topical antibiotics, steroids, and retinoids may also be prescribed to reduce pimples and improve the overall appearance of your skin.

Preventing Eczema and Acne

Preventing eczema and acne begins with avoiding triggers that can make symptoms worse.

Avoiding exposure to tight and irritating fabrics, extreme temperatures, harsh or abrasive skin products, and fragrances can help prevent an eczema flare-up. Eczema flare-ups can also be triggered by allergies to food, most especially dairy, wheat, eggs, peanuts, soy, and shellfish allergies.

Proper skin care is also important for preventing eczema and acne. A gentle skin cleanser and moisturizer can help keep your skin clean and hydrated while maintaining its normal barrier function.

Avoid scratching or picking at eczema lesions and acne pimples. This can introduce bacteria into the skin and cause a secondary skin infection.

Summary

Eczema and acne both cause irritated and inflamed skin lesions, but they have different symptoms and causes. Eczema is caused by a hypertensive reaction, while acne develops as a result of clogged pores. Eczema also causes itching, which acne doesn't.

Eczema and acne are treated differently but benefit from a proper skincare routine, including gentle cleansing and daily moisturizing.