Case 13 presents a 15-year-old female patient with irregular menses and moderate acne. Adrenal androgen production and dehydroepiandrosterone (DHEA) and DHEA-S levels were checked, excluding PCOS. Treatment comprised adapalene plus BPO gel, a CERs-containing wash, and a moisturizer with sunscreen. The patient was advised that the adapalene and BPO gel can be placed on top of the moisturizer to avoid retinoid dermatitis or consider a short contact application.6
Case 14 is a 16-year-old male patient with greasy, oily skin presented mild comedonal acne on the face, chest, and back. This typical acne case was treated with topical tazarotene, a gentle cleanser, and CERs- containing moisturizer.
Case 15 is a 16-year-old female patient with severe acne. Referral to an endocrinologist for PCOS and metabolic syndrome workup was organized and confirmed the diagnosis of genetics-related PCOS. Treatment was comprised of oral contraceptive pills (OCP), topical adapalene, and a BPO wash. If the response to the treatment is inadequate, spironolactone or oral retinoids may be considered with prescribing oral antibiotics in the month before starting the oral retinoid. Further, a gentle cleanser and CERs-containing moisturizer with SPF were used.
Case 16 The 17-year-old male patient with severe acne was referred to a pediatric dermatologist. His condition required oral isotretinoin, which can result in dry skin.34 Both the patient and parents were informed about acne, preventing further PIH, the treatment and adverse events, and measures to combat skin dryness. Physicians should consider the psychosocial aspects of acne (e.g., depression, mood effects of drugs such as oral contraceptives and isotretinoin). Skincare was comprised or a CERs-containing hydrating facial cleanser, a healing ointment, and a moisturizer plus SPF.
A consensus paper stated that dryness and skin irritation resulting from acne treatment could be improved using ceramide-containing cleansers and moisturizers, enhancing treatment adherence.36 The type of acne and individual patient characteristics can help determine the appropriate nonprescription skincare when used with topical or systemic acne therapies.5,6,36-41
Case 14 is a 16-year-old male patient with greasy, oily skin presented mild comedonal acne on the face, chest, and back. This typical acne case was treated with topical tazarotene, a gentle cleanser, and CERs- containing moisturizer.
Case 15 is a 16-year-old female patient with severe acne. Referral to an endocrinologist for PCOS and metabolic syndrome workup was organized and confirmed the diagnosis of genetics-related PCOS. Treatment was comprised of oral contraceptive pills (OCP), topical adapalene, and a BPO wash. If the response to the treatment is inadequate, spironolactone or oral retinoids may be considered with prescribing oral antibiotics in the month before starting the oral retinoid. Further, a gentle cleanser and CERs-containing moisturizer with SPF were used.
Case 16 The 17-year-old male patient with severe acne was referred to a pediatric dermatologist. His condition required oral isotretinoin, which can result in dry skin.34 Both the patient and parents were informed about acne, preventing further PIH, the treatment and adverse events, and measures to combat skin dryness. Physicians should consider the psychosocial aspects of acne (e.g., depression, mood effects of drugs such as oral contraceptives and isotretinoin). Skincare was comprised or a CERs-containing hydrating facial cleanser, a healing ointment, and a moisturizer plus SPF.
A consensus paper stated that dryness and skin irritation resulting from acne treatment could be improved using ceramide-containing cleansers and moisturizers, enhancing treatment adherence.36 The type of acne and individual patient characteristics can help determine the appropriate nonprescription skincare when used with topical or systemic acne therapies.5,6,36-41
CONCLUSION
Pediatric acne can be categorized by age and pubertal status and deserves more attention from healthcare providers treating children regarding differential diagnosis, treatment, and maintenance. Therefore, the advisors used pediatric acne expressions to define pediatric acne patient profiles, treatment, and maintenance approaches using prescription and nonprescription acne products, and skincare.
Although treatment principles are the same as adolescent acne, not all prescription treatments are approved for use in children younger than nine years. Nonprescription acne treatment products and skincare play an important role as a monotherapy, adjunctive, and maintenance treatment in pediatric acne; however, their role in pediatric acne is not well defined and requires more studies.
Acne is associated with decreased ceramide levels, and acne treatments often impair skin barrier function. CERs-containing skincare, including cleansers and moisturizers, may offer additional benefits for pediatric acne patients.
Although treatment principles are the same as adolescent acne, not all prescription treatments are approved for use in children younger than nine years. Nonprescription acne treatment products and skincare play an important role as a monotherapy, adjunctive, and maintenance treatment in pediatric acne; however, their role in pediatric acne is not well defined and requires more studies.
Acne is associated with decreased ceramide levels, and acne treatments often impair skin barrier function. CERs-containing skincare, including cleansers and moisturizers, may offer additional benefits for pediatric acne patients.
DISCLOSURES
The authors disclosed receipt of an unrestricted educational
grant from CeraVe US for support with the research of this work.
The authors also received consultancy fees for their work on this
project.
ACKNOWLEDGMENT
All authors participated in all the steps of the project, selection of the literature, and review of the manuscript.
All authors read and approved the final version of the manuscript.
All authors read and approved the final version of the manuscript.
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2. Hay RJ, Johns NE, Williams HC, Bolliger IW, Dellavalle RP, Margolis DJ, 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, Del Rosso J, Baldwin H, et al. Evidence-based recommendations for the diagnosis and treatment of pediatric acne. American Acne and Rosacea Society. Pediatrics. 2013; 131 Suppl 3:S163-86. PMID: 23637225.
6. Schachner LA, Eichenfield L, Andriessen A et al. Consensus on neonatal through preadolescent acne. J Drugs Dermatol. 2020;19(6):1-10. doi:10.36849/JDD.2020.5065
7. Skroza N, Tolino E, Potenza C et al. Adult acne versus adolescent acne. J Clin Aesthet Dermatol. 2018;11(1):21-25.
8. Perkins AC, Maglione J, Hillebrand GG, et al. Acne vulgaris in women: prevalence across the life span. J Womens Health (Larchmt). 2012;21(2):223– 230.
9. Boer M, Duchnik E, Maleszka R, Marchlewicz M. Structural and biophysical characteristics of human skin in maintaining proper epidermal barrier function. Postepy dermatologii i alergologii. 2016;33(1):1-5.
10. Thiboutot D, Del Rosso JQ. Acne vulgaris and the epidermal barrier: is acne vulgaris associated with inherent epidermal abnormalities that cause impairment of barrier functions? do any topical acne therapies alter the structural and/or functional integrity of the epidermal barrier? J Clin Aesthet Dermatol. 2013;6(2):18-24.
11. Melnik BC. Linking diet to acne metabolomics, inflammation, and comedogenesis: an update. Clin Cosmet Investig Dermatol. 2015;8:371-88.
12. Lovaszi M, Szegedi A, Zouboulis CC, Torocsik D. Sebaceous-immunobiology is orchestrated by sebum lipids. Dermatoendocrinol. 2017;9(1):e1375636.
13. Elsaie ML. Hormonal treatment of acne vulgaris: an update. Clin Cosmet Investig Dermatol. 2016;9:241-8.
14. Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, Berson DS, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945-73.e33. http://dx.doi.org/10.1016/j. jaad.2015.12.037
