Mid-childhood Acne
A referral to a pediatric endocrinologist and a workup is warranted for mid-childhood acne (ages 1 to < 7 years) (Figure 3).5,6,10 Depending on the type and severity of acne, recommendations include topical retinoids (tretinoin, adapalene, and tazarotene) or topical antimicrobials (benzoyl peroxide [BPO], clindamycin, or erythromycin) (Table 1).5,6,10 Fixed combinations of topical treatments (BPO + adapalene, BPO + clindamycin, tretinoin + clindamycin or BPO + tretinoin) may also be used. Nonprescription antimicrobials may be suitable for these patients, and in all cases, skincare products with gentle cleansers and moisturizers is ongoing (Table 2).5,6,10
Preadolescent Acne
Preadolescent acne has become more common and may occur in children aged 7 to 12 years or for females up to menarche.5,6,23-26 Few epidemiological studies have been conducted on this population.25,26 Patients with preadolescent acne may experience psychological stress due to unfavorable perceived appearance changes, increased social impairment, and even mental health problems.3,4,25,26
Preadolescent acne often presents as comedones, covering the central forehead or the central part of the face, eg, the brow, nose, lips, and even ears (Figure 4).25,26 Early diagnosis and prompt initiation of treatment may prevent emotional
Adolescent Acne
stress and possible sequelae such as post-inflammatory hyperpigmentation (PIH) and scarring.27-29 Treatment options for comedonal acne include topical retinoids (tretinoin, adapalene, and tazarotene) or topical antimicrobials (BPO, clindamycin, or erythromycin).5,6,10 Nonprescription antimicrobials may be recommended if applicable for these patients.5,6,10-12 Fixed combinations of topical treatments (BPO + adapalene, BPO + clindamycin, tretinoin + clindamycin, or BPO + tretinoin) may also be used. These treatment options may irritate the skin or cause dryness.6,10,14-18 Therefore, treatment should always be combined with skincare products containing lipids like ceramides to help manage barrier disruption commonly associated with acne and related prescription treatment.6,10,14-18 If the patient does not respond to treatment, referral to a pediatric dermatologist is indicated for further assessment and treatment recommendations.5,6,10
Adolescent Acne
Adolescent acne occurs in individuals aged 12 to 19 years or after menarche for girls and puts a significant burden on the quality of life of these patients.30-35 Adolescent acne patients may be susceptible to opinions expressed in social media about their condition and develop unrealistic notions about their appearance.33 Severe mental health conditions such as anxiety, suicide attempts, and body dysmorphic disorders have been reported in acne patients.34,35
