Evidence-Based Recommendations for the Diagnosis and Treatment of Pediatric Acne

Abstract

INTRODUCTION: Acne vulgaris is one of the most common skin conditions in children and adolescents. The presentation, differential diagnosis, and association of acne with systemic pathology differs by age of presentation. Current acknowledged guidelines for the diagnosis and management of pediatric acne are lacking, and there are variations in management across the spectrum of primary and specialty care. The American Acne and Rosacea Society convened a panel of pediatric dermatologists, pediatricians, and dermatologists with expertise in acne to develop recommendations for the management of pediatric acne and evidence-based treatment algorithms. METHODS: Ten major topic areas in the diagnosis and treatment of pediatric acne were identified. A thorough literature search was performed and articles identified, reviewed, and assessed for evidence grading. Each topic area was assigned to 2 expert reviewers who developed and presented summaries and recommendations for critique and editing. Furthermore, the Strength of Recommendation Taxonomy, including ratings for the strength of recommendation for a body of evidence, was used throughout for the consensus recommendations for the evaluation and management of pediatric acne. Practical evidence-based treatment algorithms also were developed. RESULTS: Recommendations were put forth regarding the classification, diagnosis, evaluation, and management of pediatric acne, based on age and pubertal status. Treatment considerations include the use of over-the-counter products, topical benzoyl peroxide, topical retinoids, topical antibiotics, oral antibiotics, hormonal therapy, and isotretinoin. Simplified treatment algorithms and recommendations are presented in detail for adolescent, preadolescent, infantile, and neonatal acne. Other considerations, including psychosocial effects of acne, adherence to treatment regimens, and the role of diet and acne, also are discussed. CONCLUSIONS: These expert recommendations by the American Acne and Rosacea Society as reviewed and endorsed by the American Academy of Pediatrics constitute the first detailed, evidence-based clinical guidelines for the management of pediatric acne including issues of special concern when treating pediatric patients.

The Diagnosis of Polycystic Ovary Syndrome during Adolescence

“…While comedonal acne is common in adolescent girls, moderate or severe comedonal acne (i.e., 10 or more facial lesions) in early puberty or moderate inflammatory acne through the perimenarcheal years is uncommon (<5% prevalence) [42,43] .…”

Infantile acne

“…1 All cases of acne presenting in midchildhood (age one to seven years) should be investigated for hyperandrogenism. 1,2,4 Unlike neonatal acne, infantile acne can result in scarring. The risk of scarring is difficult to estimate but increases with severity of acne and in patients with darker skin.…”

“…4 Topical treatments are effective in mild cases of infantile acne consisting of comedones and pustules and include benzoyl peroxide, retinoids, azelaic acid and antibiotics. 3,4 Oral antibiotics (erythromycin or trimethoprim) or oral isotretinoin can be used for severe infantile acne involving deep nodules and cysts. 3,4 …”

“…3,4 Oral antibiotics (erythromycin or trimethoprim) or oral isotretinoin can be used for severe infantile acne involving deep nodules and cysts. 3,4 …”

Polycystic ovary syndrome in adolescence: diagnostic and therapeutic strategies

“…Androgenic steroids and some antiseizure medications may cause clinical features similar to those seen in PCOS, and medications commonly used to treat acne may resolve or mask some PCOS features (17).…”