Update on pediatric acne treatments

Dividing the pediatric population into three age groups helps streamline effective treatment for acne.

In the youngest group, it is important to distinguish between neonatal acne, which starts in the first few weeks of life and is self-limited and resolves on its own, and acne in older babies (between 1 and 12 months) that may cause scarring, according to Karen Chernoff, MD, FAAD, a pediatric dermatologist at Weill Cornell Medicine and New York-Presbyterian in New York City.

For scarring, these patients are treated similar to acne in older children by starting with topical antibiotics or topical retinoids, such as tretinoin (Retin-A), and for most severe cases, oral antibiotics. “Typically, we improve the acne and we prevent further scarring,” Dr. Chernoff tells Dermatology Times in a follow-up interview about her pediatric acne presentation at the Summer American Academy of Dermatology (AAD) meeting.

Acne in the second age group (children between 1 and 7 years old) can sometimes be a marker of precocious puberty or certain endocrine diseases, including polycystic ovary syndrome (PCOS), and may require further testing.

If standard first-line therapies prove ineffective for treating acne in the older group (preadolescents and teens), hormonal treatments like oral contraceptives or spironolactone may achieve success in older teen girls.

Dr. Chernoff says there is data to support that clinicians are using oral antibiotics to treat acne for a longer course of time that is recommended. “The current AAD guidelines state that oral antibiotics should be used up to 4 months, ideally” she conveys. However, a study published earlier this year found that about one-third of patients with severe acne who eventually were treated with isotretinoin (Accutane) received over 1 year of oral antibiotics.

“It is important that we use oral antibiotics more as a short-term or medium-term treatment, and then transition these children to some other medication, such as topical therapy or isotretinoin,” Dr. Chernoff says.

The two dietary factors that can sometimes make acne worse are high glycemic index diets (sugar and simple carbohydrates) and excessive dairy intake.

Advancements in laser treatment for acne scars can also “be really helpful,” Dr. Chernoff says.