accompanies acne 101 may help; and, early and effective acne treatment may prevent PIH.9,37
Pediatricians recognize the importance of PIH in patients with acne and typically refer these cases to a dermatologist.5,6,9,37 Negotiation around cultural practices in skin and hair care may be necessary; if patients do not discontinue oily hair products, they can put a towel on their pillow to prevent the face from absorbing the product.9,38
The advisors agreed that some retinoids are more appropriate than others for treating patients with PIH, but providers have little control over what products patients receive because of insurance coverage.
Pediatricians recognize the importance of PIH in patients with acne and typically refer these cases to a dermatologist.5,6,9,37 Negotiation around cultural practices in skin and hair care may be necessary; if patients do not discontinue oily hair products, they can put a towel on their pillow to prevent the face from absorbing the product.9,38
The advisors agreed that some retinoids are more appropriate than others for treating patients with PIH, but providers have little control over what products patients receive because of insurance coverage.
CASE 8
A 17-year-old boy with severe facial acne (self-rated severity 7/10 [10 being worst]) since age 14 (Table 8). The patient medical history included asthma and an easily upset stomach. The youngest of 3 boys in the 12th grade, he enjoys playing football and is considering attending an in-state college. After discussing the therapy options, the mother deferred oral isotretinoin. Oral minocycline 100 mg twice daily was started while continuing with tretinoin 0.025% cream, a facial wash, and a BPO wash for showering. Although he complied with the treatment plan and no adverse events occurred, his facial condition did not improve by his week 4 follow up. He rates his acne at 6/10 in severity. The physician again discussed the treatment options and repeated the recommendation for oral isotretinoin. The mother remained reluctant to consider isotretinoin as the patient has had a borderline elevation of cholesterol in the past and has a family history of fatty liver. The antibiotic was switched to oral trimethoprim-sulfamethoxazole (Bactrim) double strength (1 tablet twice daily), continuing the topical regime and skin care. On follow up at 4 to 6 weeks, his acne had not improved, and oral isotretinoin at 20 mg daily was started and slowly titrated up to 60 mg. No cholesterol, liver, or any other laboratory abnormalities occurred. Skin care was changed to a ceramidecontaining facial cleanser and a healing ointment for the lips.
At the next visit, the acne had cleared, and some residual erythema on his cheeks remained.
Takeaways/clinical pearls: Education is crucial when guiding patients and parents to try and continue oral isotretinoin for severe acne. Physicians should explain that oral isotretinoin can be started at a low dose and slowly titrated up. In addition, they can ask the patient if they have seen friends at school who have had success with oral isotretinoin or if their friends have noticed a difference in their skin condition. When starting oral isotretinoin, patients can experience a "purging effect" and may need re-education on primary skin care to prevent irritation.39-41
At the next visit, the acne had cleared, and some residual erythema on his cheeks remained.
Takeaways/clinical pearls: Education is crucial when guiding patients and parents to try and continue oral isotretinoin for severe acne. Physicians should explain that oral isotretinoin can be started at a low dose and slowly titrated up. In addition, they can ask the patient if they have seen friends at school who have had success with oral isotretinoin or if their friends have noticed a difference in their skin condition. When starting oral isotretinoin, patients can experience a "purging effect" and may need re-education on primary skin care to prevent irritation.39-41
LIMITATIONS
The cases are intended to illustrate the real-world experience
rather than reflect a controlled clinical trial data environment,
nor do they mirror statistical outcomes. The use of the ceramidecontaining
cleanser and moisturizer is at the discretion of the
treating health care professional after careful clinical evaluation.
SUMMARY AND CONCLUSIONS
The presented pediatric acne case series aims to educate health care providers treating children with acne to tailor acne prescription, nonprescription therapy, skin care, and maintenance treatment to improve patient outcomes.
The 8 cases covered neonatal acne: birth to ≤ 8 weeks; preadolescent acne: ≥7 to 12 years; and adolescent acne: ≥12 to 19 years or after menarche for girls.
Skincare products containing lipids such as ceramides promote a healthy skin barrier in acne monotherapy, adjunctive, and maintenance treatment. However, further studies are needed to define their role in pediatric acne and to integrate skin care into treatment regimens, guidelines, and algorithms for pediatric acne.
Sharing best practices in acne therapy and maintenance treatment for pediatric patients with acne may support health care providers treating children to improve clinical outcomes.
The 8 cases covered neonatal acne: birth to ≤ 8 weeks; preadolescent acne: ≥7 to 12 years; and adolescent acne: ≥12 to 19 years or after menarche for girls.
Skincare products containing lipids such as ceramides promote a healthy skin barrier in acne monotherapy, adjunctive, and maintenance treatment. However, further studies are needed to define their role in pediatric acne and to integrate skin care into treatment regimens, guidelines, and algorithms for pediatric acne.
Sharing best practices in acne therapy and maintenance treatment for pediatric patients with acne may support health care providers treating children to improve clinical outcomes.
DISCLOSURES
The authors disclose receipt of an unrestricted educational grant from CeraVe US for support with the research of this work; they also received consultancy fees for their work on this project.
All the authors developed the manuscript, reviewed it, and agree with its content.
The authors gave kind permission to use the photographs of the clinical cases they performed and obtained consent and permission from the patients' caregivers to use the photographs in the publication.
All the authors developed the manuscript, reviewed it, and agree with its content.
The authors gave kind permission to use the photographs of the clinical cases they performed and obtained consent and permission from the patients' caregivers to use the photographs in the publication.
REFERENCES
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2. Hay RJ, Johns NE, Williams HC, et al. The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. J Invest Dermatol. 2014;134(6):1527-34.
3. Revol O, Milliez N, Gerard D. Psychological impact of acne on 21st-century adolescents: decoding for better care. Br J Dermatol. 2015;172 (Suppl. 1):52-58
4. Gordon RA, Crosnoe R, Wang X. Physical attractiveness and the accumulation of social and human capital in adolescence and young adulthood: assets and distractions. Monogr Soc Res Child Dev. 2013; 78:1-137
5. Eichenfield LF, Krakowski AC, Piggott C, et al. Evidence-based recommendations for the diagnosis and treatment of pediatric acne. American Acne and Rosacea Society. Pediatrics. 2013 May; 131 Suppl 3:S163-86. PMID: 23637225.
2. Hay RJ, Johns NE, Williams HC, et al. The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. J Invest Dermatol. 2014;134(6):1527-34.
3. Revol O, Milliez N, Gerard D. Psychological impact of acne on 21st-century adolescents: decoding for better care. Br J Dermatol. 2015;172 (Suppl. 1):52-58
4. Gordon RA, Crosnoe R, Wang X. Physical attractiveness and the accumulation of social and human capital in adolescence and young adulthood: assets and distractions. Monogr Soc Res Child Dev. 2013; 78:1-137
5. Eichenfield LF, Krakowski AC, Piggott C, et al. Evidence-based recommendations for the diagnosis and treatment of pediatric acne. American Acne and Rosacea Society. Pediatrics. 2013 May; 131 Suppl 3:S163-86. PMID: 23637225.
