Triggered by a pattern of innate inflammation, pediatric acne may manifest underlying pathology.5,6 Workup, when necessary, is based on age and physical findings, including morphology and distribution of acne lesions and age-related physical conditions.5,6,10
The pathogenesis of acne is thought to be similar at all ages, including pediatric acne.5,6,10-17 However, treatment and maintenance may differ due to the state of skin maturity and concerns about the safety and efficacy of various therapies in young age groups.5,6,10-17
Mild pediatric acne treatment may start with topical benzoyl peroxide (BPO) or a low-strength topical retinoid. Other options are topical fixed combination therapy such as BPO plus antibiotic, BPO plus retinoid, or a combination of BPO, antibiotic, and retinoid.5,6,10-17 Treatment recommendations for moderate pediatric acne may start with topical treatment similar to mild conditions.5,6,10-17 Other options may be an oral antibiotic combined with topical retinoid plus BPO.5,6,10-17 Inadequate response to therapy is a consideration to changing the type or the formulation of the topical-treatment.5,6,10-17 For females, hormonal therapy may be an option.5,6,10-17
An oral antibiotic may be given together with a fixed combination topical treatment for severe pediatric acne.5,6,10-17 If the treatment response is inadequate, oral antibiotic or oral isotretinoin may be an option; consider hormonal therapy for females.5,6,10-17
Acne prescription treatments in children younger than 12 years of age are considered off-label, though they may represent the community standard of care.10-17
For pediatric acne, nonprescription acne products and skin care using cleansers and moisturizers should play an essential part in acne treatment and maintenance approaches.5,6,10,17 However, within the available acne treatment consensuses, there is a knowledge gap on nonprescription cleansers and moisturizers for pediatric acne.6,10
The advisors' previous publication10 aimed to improve outcomes in pediatric patients with acne by giving more attention to the use skincare cleansers and moisturizers to educate health care providers who treat children. The advisors defined various expressions of pediatric acne to educate and tailor nonprescription acne treatment and skin care using cleansers and moisturizers as mono or adjuncts to prescription treatment.10 The current pediatric acne patient case series describes the clinical experience with treatments, including skin care, to address the knowledge gap in prescription, nonprescription acne treatments, and skincare products for pediatric acne.
The pathogenesis of acne is thought to be similar at all ages, including pediatric acne.5,6,10-17 However, treatment and maintenance may differ due to the state of skin maturity and concerns about the safety and efficacy of various therapies in young age groups.5,6,10-17
Mild pediatric acne treatment may start with topical benzoyl peroxide (BPO) or a low-strength topical retinoid. Other options are topical fixed combination therapy such as BPO plus antibiotic, BPO plus retinoid, or a combination of BPO, antibiotic, and retinoid.5,6,10-17 Treatment recommendations for moderate pediatric acne may start with topical treatment similar to mild conditions.5,6,10-17 Other options may be an oral antibiotic combined with topical retinoid plus BPO.5,6,10-17 Inadequate response to therapy is a consideration to changing the type or the formulation of the topical-treatment.5,6,10-17 For females, hormonal therapy may be an option.5,6,10-17
An oral antibiotic may be given together with a fixed combination topical treatment for severe pediatric acne.5,6,10-17 If the treatment response is inadequate, oral antibiotic or oral isotretinoin may be an option; consider hormonal therapy for females.5,6,10-17
Acne prescription treatments in children younger than 12 years of age are considered off-label, though they may represent the community standard of care.10-17
For pediatric acne, nonprescription acne products and skin care using cleansers and moisturizers should play an essential part in acne treatment and maintenance approaches.5,6,10,17 However, within the available acne treatment consensuses, there is a knowledge gap on nonprescription cleansers and moisturizers for pediatric acne.6,10
The advisors' previous publication10 aimed to improve outcomes in pediatric patients with acne by giving more attention to the use skincare cleansers and moisturizers to educate health care providers who treat children. The advisors defined various expressions of pediatric acne to educate and tailor nonprescription acne treatment and skin care using cleansers and moisturizers as mono or adjuncts to prescription treatment.10 The current pediatric acne patient case series describes the clinical experience with treatments, including skin care, to address the knowledge gap in prescription, nonprescription acne treatments, and skincare products for pediatric acne.
MATERIALS AND METHODS
The case series aims to meet a significant unmet need, as there is currently a lack of literature on the role of skincare in managing pediatric acne.6,10
A panel of 8 advisors in pediatric dermatology, dermatology, and pediatrics who treat pediatric patients with acne convened a meeting on February 12, 2022. Each advisor presented pediatric patient cases from their practice in which a ceramidecontaining skincare regime was used as adjunctive treatment or monotherapy for pediatric patients with acne. All advisors used the same template for gathering the case information. They addressed the following questions: 1) Why did you select this patient? 2) What was used previously for this patient (treatment and adjunctive skin care)? 3) What type of prevention and education was provided? 4) What type of skin care was given (monotherapy, adjunctive, or maintenance treatment)? 4) What type of therapy was given? 5) What was the treatment plan? 6) What was the status upon follow-up? 7) What are the lessons learned? 8) What are the key takeaways and clinical pearls from the case?
The advisors felt the case studies presented during the meeting are a comprehensive collection of typical presentations covering the necessary teaching points. Of the 17 cases presented during the meeting, the advisors agreed to select 8 cases covering various ages and skin types, including skin of color (SOC), and provide a logical flow from youngest to oldest patient.
Pediatric Patients With Acne Case Series
Neonatal Acne
The first 2 cases concern a 3-week-old boy and a 1-month-old boy with neonatal acne.5,6
Neonatal acne occurring at 0 to 8 weeks of life is estimated to affect 20% of newborns and occurs more frequently in boys than girls.5,6 This type of acne usually presents with small erythematous papules and pustules on the face, rarely with comedones.5,6,10 Eruptions due to other causes, such as bacterial folliculitis, secondary syphilis, herpes simplex virus, and varicella-zoster virus, need to be excluded.5,6,10-13 Further conditions presenting eruptions include transient neonatal pustular melanosis, erythema toxicum neonatorum, eosinophilic pustular folliculitis, sebaceous gland hyperplasia, and congenital adrenal hyperplasia.5,6,10-13 Neonatal cephalic pustulosis presents with monomorphic red papules or pustules on the face and neck without comedones due to Malassezia yeasts colonization.5,6,10-13 Maternal medications may also cause neonatal eruptions and should be checked; for instance, lithium, phenytoin, and corticosteroids.5,6,10-13
A panel of 8 advisors in pediatric dermatology, dermatology, and pediatrics who treat pediatric patients with acne convened a meeting on February 12, 2022. Each advisor presented pediatric patient cases from their practice in which a ceramidecontaining skincare regime was used as adjunctive treatment or monotherapy for pediatric patients with acne. All advisors used the same template for gathering the case information. They addressed the following questions: 1) Why did you select this patient? 2) What was used previously for this patient (treatment and adjunctive skin care)? 3) What type of prevention and education was provided? 4) What type of skin care was given (monotherapy, adjunctive, or maintenance treatment)? 4) What type of therapy was given? 5) What was the treatment plan? 6) What was the status upon follow-up? 7) What are the lessons learned? 8) What are the key takeaways and clinical pearls from the case?
The advisors felt the case studies presented during the meeting are a comprehensive collection of typical presentations covering the necessary teaching points. Of the 17 cases presented during the meeting, the advisors agreed to select 8 cases covering various ages and skin types, including skin of color (SOC), and provide a logical flow from youngest to oldest patient.
Pediatric Patients With Acne Case Series
Neonatal Acne
The first 2 cases concern a 3-week-old boy and a 1-month-old boy with neonatal acne.5,6
Neonatal acne occurring at 0 to 8 weeks of life is estimated to affect 20% of newborns and occurs more frequently in boys than girls.5,6 This type of acne usually presents with small erythematous papules and pustules on the face, rarely with comedones.5,6,10 Eruptions due to other causes, such as bacterial folliculitis, secondary syphilis, herpes simplex virus, and varicella-zoster virus, need to be excluded.5,6,10-13 Further conditions presenting eruptions include transient neonatal pustular melanosis, erythema toxicum neonatorum, eosinophilic pustular folliculitis, sebaceous gland hyperplasia, and congenital adrenal hyperplasia.5,6,10-13 Neonatal cephalic pustulosis presents with monomorphic red papules or pustules on the face and neck without comedones due to Malassezia yeasts colonization.5,6,10-13 Maternal medications may also cause neonatal eruptions and should be checked; for instance, lithium, phenytoin, and corticosteroids.5,6,10-13
