Evaluation and treatment of acne from infancy to preadolescence

Abstract

Acne vulgaris is a common inflammatory skin condition affecting most individuals at some point during their lives. Although acne is more commonly seen in adolescents, it can be seen in younger patients as well. It can be useful to classify pediatric acne based on the age of presentation as infantile, mid-childhood, or preadolescent. We describe a practical approach to the evaluation and treatment of acne in each of these age groups.

Pediatric Acne

“…However, it can also develop in later periods, such as the 14th and 16th months [4,15]. Infantile acne is more diffuse, inflamed, and persistent [3].…”

“…Zona reticularis which is the androgen-secreting part of fetal adrenal gland is large in both girls and boys and it gradually gets smaller beginning at age 1, during childhood period [8,15]. It is thought that high levels of dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS) secreted as a result of the continuation of fetal adrenal gland function after the neonatal period causes acne development by stimulating the sebaceous glands [4,8].…”

“…However, if the lesions are persistent, severe, and unresponsive to treatment, or if there is a finding of hyperandrogenism in the physical examination of the infant (pubic hair, cliteromegaly, hirsutism, alopecia, accelerated growth, etc. ), additional laboratory investigations for underlying abnormalities should be performed [2,7,15]. Measurements of bone age, serological tests such as follicle-stimulating hormone (FSH), LH, free and total testosterone, DHEA, DHEAS, 17β-hydroxyprogesterone, prolactin, and adrenocorticotropic hormone (ACTH) stimulation test should be performed [2,4].…”

“…In addition to premature adrenarche, which is a completely benign event, more severe conditions such as congenital adrenal hyperplasia (CAH), gonadal and adrenal tumors, Cushing's syndrome, central precocious puberty, and exogenous androgen absorption should be excluded [2,7,15]. A careful physical examination should be done for the growth chart and the presence of findings related to hormonal abnormality.…”

“…Inflamed keratosis pilaris, which is seen in the cheeks in atopic people, keratin cysts (miliaria), demodicosis, molluscum contagiosum, verruca plana, idiopathic facial aseptic granuloma, pseudoacne of the nasal crease, perioral dermatitis, and angiofibroma should be considered in the differential diagnosis of mid-childhood acne [7,15,26,27]. In the literature, dactinomycin-induced acne has been reported in this age group [28].…”