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Consensus on Neonatal Through Preadolescent Acne

June 2020 | Volume 19 | Issue 6 | Original Article | 592 | Copyright © June 2020


Published online June 5, 2020

Lawrence A. Schachner MD FAAP FAAD,a Lawrence Eichenfield MD FAAP FAAD,b Anneke Andriessen PhD,c Latanya Benjamin MD FAAP FAAD,d Bernard Cohen MD FAAP FAAD,e Fred Ghali MD FAAD FAAP,f Mercedes Gonzalez MD FAAD,g Adelaide Hebert MD FAAP FAAD,h Pearl Kwong MD PhD FAADi

aDivision of Pediatric Dermatology, Department of Dermatology and Cutaneous Surgery, Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, FL bPediatric Dermatology, Department of Dermatology, Departments of Dermatology and Pediatrics, University of California, San Diego, and Rady Children's Hospital, San Diego, CA cRadboud UMC, Nijmegen and Andriessen Consultants, Malden, The Netherlands dPediatric Dermatology, Florida Atlantic University, Boca Raton, FL eDermatology and Pediatrics at the Johns Hopkins University School of Medicine, Johns Hopkins Children Center, Baltimore, MD fDermatology, University of Texas Southwestern Medical School and the Baylor Medical Department of Dermatology, Dallas,TX gDr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL hPediatric Dermatology, McGovern School of Medicine, Children’s Memorial Hermann Hospital, Houston, TX iPediatric Dermatology, Jacksonville, FL

Abstract
Background: Acne vulgaris is the most common dermatological disorder. Pediatric acne may be a manifestation of the underlying pathology and can occur in the first weeks, months, or years of life. Acne in childhood can be categorized by age and pubertal status.
Objective: An expert panel of pediatric dermatologists and dermatologists developed a consensus paper on neonatal through preadolescent acne, providing information on differential diagnosis, prevention, treatment, and maintenance of the condition.
Methods: A systematic literature review explored present clinical guidelines, treatment options, and therapeutic approaches addressing neonatal through preadolescent acne. The information from the literature searches was used together with the panel’s expert opinion and experience to adopt consensus statements following established standards.
Results: The panel members reached unanimous consensus on seven statements addressing the various age categories of pediatric acne: neonatal acne: birth to ≤ 8 weeks; infantile acne: 8 weeks to ≤1 year; mid-childhood acne: 1 year to <7 years; preadolescent acne: ≥7 to 12 years; adolescent acne: ≥12 to 19 years or after menarche for girls. Health care providers treating children need to pay more attention to pediatric acne and should monitor the risk of endocrine-associated abnormalities, especially in mild-childhood acne. When prescribing acne treatment, newer medications approved for use in children older than nine years of age may offer a suitable option.
Conclusion: The differential diagnosis of pediatric acne, as well as its treatment and maintenance, requires much more attention and consideration from health care providers treating children. J Drugs Dermatol. 2020;19(6):592-600. doi:10.36849/JDD.2020.5065

INTRODUCTION

Acne vulgaris, the most common dermatological disorder, can occur in the first weeks, months, or years of life.1-3 Pediatric acne can be categorized by age and pubertal status. Acne flares may precede other signs of pubertal maturation.3

Psychological and emotional distress due to acne vulgaris, including poor self-esteem, social anxiety, depression, and suicidal ideation, have been reported in various studies.4,5

Acne vulgaris is a complex multifactorial disease and its pathophysiology is incompletely elucidated.1 The pathogenesis of pediatric acne appears to be similar to acne at all ages, although the approach to treatment may differ due to the state of skin maturity and variable safety and efficacy of treatments in different age groups.3 The presence of acne in childhood may be a manifestation of underlying pathology.3 Workup is to be based on age and physical findings, including morphology and distribution of acne lesions and physical condition in relation to age.3

An impaired skin barrier function in acne has been reported.6-9 A compromised barrier may influence other functional properties, including elevated sebum secretion, enlarged sebaceous glands, and the presence of subclinical inflammation.6-9 Also, ultrastructural properties are altered; for instance, filaggrin expression is enhanced and there may be a reduction of free