Raegan Hunt, service chief of pediatric dermatology at Texas Children’s Hospitals and assistant professor of dermatology and pediatrics at the Baylor College of Medicine, explains diagnosing and treating acne in pre-adolescent children along with recognizing it early to rule out underlying endocrinologic abnormalities.

Among neonatal acne and infantile acne, she rendered later to be more worrisome. Neonatal acne aka benign cephalic pustulosis develops in neonates (0-1.5 months of age), without comedones, cysts, or acne scarring. It is self-resolving and can be cleared rapidly with gentle cleansers and topical antifungal medications.

Infantile acne is uncommon, seen more frequently in male patients (1.5 to 12 months) with a risk of scarring. It is linked with an increased risk of adolescent acne, comedones, inflammatory papules, acne cysts and nodules. It is treated with topical medications e.g. benzoyl peroxide, retinoids, and azelaic acid or systemic medications e.g. erythromycin or trimethoprim/sulfamethoxazole (TMX-SMX not to be used in patients <3 months of age). For severe treatment-resistant cases, isotretinoin can be used off-label.

Further, it is difficult for young babies to swallow isotretinoin capsules so the oily medication vehicle should be removed from the capsule and given by mouth or the capsules can even be frozen and cut.

Secondly, Hunt also explained about mid-childhood acne (develops between ages 1-7 years) that can be associated with endocrinologic disorders, like a tumor, Cushing syndrome, or premature adrenarche. Thus demanding an endocrine laboratory workup, including tests like follicle-stimulating hormone (FSH), luteinizing hormone (LH), dehydroepiandrosterone sulfate (DHEAS), cortisol, free and total testosterone, 17-OH progesterone, and a bone age x-ray.

Mid-childhood acne presents with comedones, inflammatory papules, and nodules. It possesses a risk of scarring and treatment includes topical retinoids, benzoyl peroxide, and topical and oral antibiotics. Further, tetracycline derivatives should be avoided in pediatric patients <8 years old for acne treatment.

Pre-adolescent acne occurs in children between 8 to 12 years of age and has clinical findings, treatment, and risk of scarring similar to mid-childhood acne. This group does not demand an endocrine workup.

Demodicosis, in children, can be associated with disorders like Langerhans cell histiocytosis, leukaemia, lymphoma, and HIV. It may also exacerbate pediatric periorificial dermatitis, secondarily.

Assessing the acne type and treating them according to the severity and acne type is recommended. Combination of estrogen-progestin oral contraceptive pill and/or isotretinoin beyond standard first-line acne treatments with a combination of topical retinoid, topical and/or oral antibiotic therapy, can also be utilized. 

Source- Dermatology Times [Internet]. Pediatric Acne: What Signs are Concerning? October 2, 2021. Available from: https://www.dermatologytimes.com/view/pediatric-acne-what-signs-are-concerning-