Although pediatric acne reportedly affects up to 87% of teenagers, a 1994 study found acne in 78% of 365 girls, ages 9 and 10, stated Lawrence Eichenfield, MD, of Rady's Children's Hospital in San Diego, and colleagues in Pediatrics online.
Even babies get acne with 20% of newborns affected, they added."It is essential to have a broad understanding of acne at different ages and to be aware of the differential diagnoses for each age group," the authors stated in an evidence-based evaluation of more than 150 dermatology-related studies.
- In neonates, pustules on the face and upper body represent acne or acne-like conditions, and are best treated with 2% ketoconazole cream. Physicians should consider underlying endocrinologic diseases, tumors, or gonadal/ovarian pathology in the presence of significant acne.
- In infants to 12 months, acne is predominate in boys. Treatment can include topical antimicrobials, topical retinoids, noncycline antibiotics (erythromycin), and, occasionally, isotretinoin. None of these medications are indicated by the FDA for use in this age group, they cautioned.
- In mid-childhood up to 7 years, acne is rare, so an endocrine abnormality should be suspected and investigated. Oral tetracyclines are not an option because of the risk to developing teeth and bones.
- In preadolescence, best defined as up to the age of menarche, acne on the T-zone of the face may be the first sign of puberty. With severe acne, polycystic ovary syndrome or other endocrinologic abnormality should be considered, but pelvic ultrasound is not useful in this diagnosis.
Physicians should treat to reduce sebum (oil), prevent microcomedones (pimples), suppressP acnes (bacteria), and reduce inflammation that causes scarring, the recommendations advised.
The guidelines, endorsed by the the American Academy of Pediatrics, are segmented based on age:Among over-the-counter remedies, benzoyl peroxide appeared to be "somewhat effective" for mild acne and remained the overall go-to treatment, either alone or combined, Eichenfield and colleagues wrote. Salicylic acid was less so, they stated.
Too harsh cleaners can aggravate the condition as children strive to scrub away the acne, the authors stated. However, they pointed out that cosmetics and poor hygiene do not contribute to eruptions, and, make-up may increase patient well-being.