MauiDerm 2015: Pre-adolescent acne may be red flag

Dermatologists should keep an eye out for acne in pre-adolescent children as young as one year because pimples may be a sign of serious medical problems, a leading dermatologist told a crowd at the Maui Derm 2015 conference this week.

“It’s a red flag for underlying hormonal disturbances” in kids from ages one to seven years, says Albert C. Yan, M.D., a pediatric dermatologist and section chief of the Division of Dermatology at The Children's Hospital of Philadelphia, in an interview with Dermatology Times.

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“Look for signs of early puberty” in these cases, Dr. Yan says. He advises dermatologists to analyze the bone age of kids via X-ray, test levels of progesterone and testosterone, and consult an endocrinologist if needed.

“I had one patient who developed acne when she was five,” he says. “She had an underlying adrenal tumor. Several case reports have highlighted associations with underlying endocrine abnormalities, including tumors, that trigger this type of early acne.”

Steroid inhalers that treat asthma can also cause acne in the youngest children, he says. This can happen when parents use face masks to deliver medication to the noses of children who are too young to manipulate traditional inhalers.

As for older children, acne appears in about 5% of kids aged seven to 11 years, Dr. Yan says, and the number appears to be growing as puberty begins earlier. Kids with acne in that age range “are more likely to develop severe acne during adolescence,” he says. “Fortunately, it’s an easy problem to treat.”

Dr. Yan recommends topical retinoids and benzoyl peroxide, although he cautions that dermatologists may have to prescribe off-label.

Primary doctors and pediatricians often treat acne in these children, he says, but they frequently prescribe oral antibiotics that may not be the best approach.

More coverage from MauiDerm 2015