Treatment of Childhood Acne
Incidence of Acne in the first 20 years of life:
-3% of affected individuals are neonates
-6% in childhood (pre-adolescents)
-91% in teenagers (adolescents…predictably)
Thorough examination must be done in children to rule out differential diagnosis:
-keratosis pilaris
-miliara
-perorificial dermatatis
-pomade acne (cosmetic use)
-flat warts
-molluscum contagiosum
Scarring is a complication of acne in children and it needs to be treated accordingly
Practical Attitude: check the whole body for hypertrichosis and clitoridial hypertrophy (and other signs of hyperandrogenism) in children and then check for hormonal changes in the blood (testosterone, DHEA, Luteinizing hormone…
Presentations of acne:
-In infantile acne there is no sex predominance and the elementary lesions tend to be comedones
-Then the sex distribution is mixed.
Treatments used in the treatment of acne in childhood:
-Dermatologists tend to use adapalene, adapelene / benzoyle peroxide (BPO)
-Primary Care Physicians tend to use antibiotics as an initial treatments such as minocycline (which is a tetracycline which is contraindicated in children because of its side effects on developing teeth (discoloration))
Data is lacking in guidelines in the treatment of pre-adolescent acne.
According to the presenter’s clinical experience, mainstay treatment consists of topical retinoids and combination BPO/antibiotic. Acne is considered as more severe if metabolic disturbance is presents and in cooperation with a pediatrician, consider further therapy
Opinion on isotretinoin in children: The big issue is its effects on bone growth as it can cause premature closure of the epiphyses. it has been used in ichthyosis in Mexico in a big study. Practical advice is to give three months of oral isotretinoin, dosage 0.4-0.6 mg/Kg/d) and alternate with topical vitamin A treatments. Side effects have been shown NOT to be more enhanced than in adults. It would be even lower according to some studies. (This statement is for informational purposes only and does not replace therapeutic judgement done by a skin doctor).
Contributors
Dr Christophe Hsu – dermatologist. Geneva, Switzerland
Source of information: 2014 (10) – Gollnick H. EADV Annual Meeting, Amsterdam The Netherlands
