Joslyn Kirby, MD, discusses highlights from her lecture on Acne and Rosacea Mimickers at the 2021 Elevate-Derm Conference.
In this video
Dr. Kirby reminds clinicians that "when you hear hooves, you think horses," but sometimes acne warrants digging deeper. She points to age as a clue — around nine is roughly the lower range where she feels comfortable diagnosing a child with acne — and stresses examining the whole body of infants and younger children for signs of hyperandrogenism that may prompt an endocrinology referral. She also flags less obvious triggers beyond anabolic steroids or testosterone, including topical steroids, oral corticosteroids, and whey supplementation.
On "maskne," she notes that multiple publications show the process underneath is usually acne rather than rosacea — sometimes acne mechanica from friction, sometimes a true flare from heat, moisture, or microbiome changes. Her approach is to treat it like regular acne with benzoyl peroxide and topical retinoids, give the skin some air when possible, and try different mask materials. She closes with case reports of young men whose whey and milk-based protein supplements contributed to acne, likely in part through a higher glycemic index.
- Use age as a guide — around nine is about the lower range for comfortably diagnosing acne; younger kids warrant a whole-body look for hyperandrogenism and possible endocrinology referral.
- Look beyond anabolic steroids: topical steroids, oral corticosteroids, and whey supplementation can all trigger acne.
- Maskne is usually acne, not rosacea — treat it as regular acne with benzoyl peroxide and topical retinoids.
- Give skin some air and try changing mask materials to ease acne mechanica and mask-related flares.
- Whey and milk products carry a higher glycemic index and can contribute to acne, especially in patients using protein supplements to build muscle.
