each group used pediatric acne expressions to define 4–6 pediatric acne patient profiles. Advisors answered the following questions for each patient profile: 1) Why did you select this patient profile? 2) What would you use (treatment and adjunctive skincare)? 3) What prevention and/or education would you offer? 4) Is there a place in these patient profiles for monotherapy, adjunctive, or maintenance treatment with ceramides (CERs) containing nonprescription acne products and skincare? If so, which and why?
Literature Review
A literature search was conducted using keywords related to pediatric acne. Prior to the meeting, literature was culled on current best practices in pediatric acne, addressing nonprescription acne products and skincare as monotherapy, adjunctive, and maintenance treatment. Searches were performed on PubMed and Google Scholar on August 5th and 6th, 2021, by a dermatologist and a physician/scientist. Selected articles included guidelines, consensus papers, and reviews describing current best practices in pediatric acne treatment using acne products and skincare, clinical research studies published in the English language from 2010 to 2021. Search terms used:
Acne vulgaris, acne pathogenesis, pediatric acne, pediatric acne treatment, combination acne therapy, retinoids, benzoyl peroxide, bacterial resistance, isotretinoin, hormonal treatment, pediatric acne guidelines, algorithm, consensus recommendations.
OTC or nonprescription acne products and skincare use, pediatric acne prevention, treatment, maintenance, monotherapy, adjunctive treatment, efficacy, safety, tolerability, skin irritation of OTC acne products, and skincare use, quality of life aspects, handling and comfort, adherence to treatment.
The results of the searches were evaluated independently by two reviewers. Based on reviewer consensus, each treatment within the publications was assigned an alphanumeric level of evidence (1 to 4 and A to C), using pre-established criteria by the American Academy of Dermatology.16 Initially, 57 articles were identified, and after excluding 14 duplications and poor quality papers, 43 articles remained, of which only 14 were of sufficient quality to grade. The selected publications comprised 5 guidelines, algorithms, and consensus papers, 22 clinical studies (15 randomized controlled trials), 14 reviews, and 2 other papers.
Notably, there were no publications specifically on nonprescription pediatric acne treatment and skincare.
Pediatric Acne
Diagnosis and screening
There are various age categories of pediatric acne: neonatal acne: birth to ≤ 8 weeks; infantile acne: 8 weeks to ≤1 year; midchildhood acne: 1 year to <7 years; preadolescent acne: ≥7 to 12 years; adolescent acne: ≥12 to 19 years or after menarche for girls.5,6
Other systems consider three different groups of acne patients: preadolescent (≥7 to 12 years), adolescent (≥12-25 years), and post-adolescent patients (≥25 years; Figure 2).7,8
Adequate evaluation of children with acne requires a directed medical history and physical examination.5,6 The medical history should include the age of acne onset, duration of disease, growth parameters, and age of onset for any early signs of virilization. The physical examination should include height, weight, types, location of acne, and signs of puberty (body odor, axillary and pubic hair, breast buds, enlarged phallus, testis, or clitoris). Laboratory evaluation is indicated for patients with other signs of virilization. Hand and wrist x-ray for bone age is a simple, practical initial examination.5,6 A workup and a referral to a pediatric endocrinologist are warranted for mid-childhood acne (ages 1 to < 7 years), which is very uncommon, and patients need to be examined, especially if displaying secondary sexual characteristics.5,6 Finally, physicians should collect patient history on their diet and consider any potential contributing factors related to their acne (e.g., milk consumption).9
Details on diagnosis and the presentation of pediatric acne are in Box 1.
Literature Review
A literature search was conducted using keywords related to pediatric acne. Prior to the meeting, literature was culled on current best practices in pediatric acne, addressing nonprescription acne products and skincare as monotherapy, adjunctive, and maintenance treatment. Searches were performed on PubMed and Google Scholar on August 5th and 6th, 2021, by a dermatologist and a physician/scientist. Selected articles included guidelines, consensus papers, and reviews describing current best practices in pediatric acne treatment using acne products and skincare, clinical research studies published in the English language from 2010 to 2021. Search terms used:
Acne vulgaris, acne pathogenesis, pediatric acne, pediatric acne treatment, combination acne therapy, retinoids, benzoyl peroxide, bacterial resistance, isotretinoin, hormonal treatment, pediatric acne guidelines, algorithm, consensus recommendations.
OTC or nonprescription acne products and skincare use, pediatric acne prevention, treatment, maintenance, monotherapy, adjunctive treatment, efficacy, safety, tolerability, skin irritation of OTC acne products, and skincare use, quality of life aspects, handling and comfort, adherence to treatment.
The results of the searches were evaluated independently by two reviewers. Based on reviewer consensus, each treatment within the publications was assigned an alphanumeric level of evidence (1 to 4 and A to C), using pre-established criteria by the American Academy of Dermatology.16 Initially, 57 articles were identified, and after excluding 14 duplications and poor quality papers, 43 articles remained, of which only 14 were of sufficient quality to grade. The selected publications comprised 5 guidelines, algorithms, and consensus papers, 22 clinical studies (15 randomized controlled trials), 14 reviews, and 2 other papers.
Notably, there were no publications specifically on nonprescription pediatric acne treatment and skincare.
Pediatric Acne
Diagnosis and screening
There are various age categories of pediatric acne: neonatal acne: birth to ≤ 8 weeks; infantile acne: 8 weeks to ≤1 year; midchildhood acne: 1 year to <7 years; preadolescent acne: ≥7 to 12 years; adolescent acne: ≥12 to 19 years or after menarche for girls.5,6
Other systems consider three different groups of acne patients: preadolescent (≥7 to 12 years), adolescent (≥12-25 years), and post-adolescent patients (≥25 years; Figure 2).7,8
Adequate evaluation of children with acne requires a directed medical history and physical examination.5,6 The medical history should include the age of acne onset, duration of disease, growth parameters, and age of onset for any early signs of virilization. The physical examination should include height, weight, types, location of acne, and signs of puberty (body odor, axillary and pubic hair, breast buds, enlarged phallus, testis, or clitoris). Laboratory evaluation is indicated for patients with other signs of virilization. Hand and wrist x-ray for bone age is a simple, practical initial examination.5,6 A workup and a referral to a pediatric endocrinologist are warranted for mid-childhood acne (ages 1 to < 7 years), which is very uncommon, and patients need to be examined, especially if displaying secondary sexual characteristics.5,6 Finally, physicians should collect patient history on their diet and consider any potential contributing factors related to their acne (e.g., milk consumption).9
Details on diagnosis and the presentation of pediatric acne are in Box 1.
