Acne: Clinical Pearls

James Treat, MD

Dr James Treat provides us with an outline on the management of pediatric acne…

Acne Type and Age of Onset

  • Neonatal:  Birth to ≤6 wk
  • Infantile:  6 wk to ≤1 y
  • Mid-childhood:  1 y to <7 y
  • Preadolescent:  ≥7 to ≤12 y or menarche in girls
  • Adolescent:  ≥12 to ≤19 y or after menarche in girls

Neonatal Acne:

  • Benign, self-limited, asymptomatic eruption of erythematous papules and pustules; no comedones
    • Typically localized to cheeks, forehead, and scalp
      • But: can extend into scalp and onto the shoulders (Neonatal Cephalic Pustulosis)

Infantile Acne:

Clinical: Typically starts at around 3-6 months of age up (as young as 6 weeks) and usually lasts 6-12 months

  • Clinically this looks like adolescent acne:
    • Comedones, inflammatory papules and nodules
  • Scarring potential
  • Harbinger for later acne
  • Most Infantile acne is NOT associated with an endocrinopathy

BUT if on exam you see:

  • Excess Growth
  • Advancement of Tanner Stage
  • Cliteromegaly or enlarged testciles.

THEN: Hormonal workup, consider endocrine evaluation

  • FSH, LH, DHEAS, Free and Total Testosterone, 17 OH Progesteterone , androstendione, and Bone Age

Mid-Childhood Acne

Starts between 1 and 7 years of age.

Clinically this looks like adolescent acne:

  • Comedones, inflammatory papules and nodules
  • Scarring potential
  • Harbinger for later acne
  • This is not an age when there is normal androgen production so acne at this age requires a workup.
  • Clinical exam:
    • Excess Growth
    • Advancement of Tanner Stage
    • Cliteromegaly or enlarged testciles.

Hormonal workup and endocrine evaluation

  • FSH, LH, DHEAS, Free and Total Testosterone, 17 OH Progesterone, androstenedione and Bone Age

Treatment (off label): same as adolescent acne except NO tetracycline derivatives

  • Topical retinoids and Benzoyl Peroxide products often enough
  • Systemic choices: erythromycin derivatives, isotretinoin