Case 4 and 5 concern 8-year-old female patients with mild comedonal acne, a common skin condition. A gentle cleanser with either BPO or a SA containing formulation as monotherapy and maintenance was recommended. Additionally, twice daily, a CER containing moisturizer was applied.
Case 6
concerns a 10-year-old female patient with comedonal acne, a common pre-pubertal condition. The parents initiated the appointment with a pediatrician, and their child agreed that education and treatment might improve her skin condition. A CERs and BPO 4% containing foaming cleanser was recommended as monotherapy and maintenance.
Case 7
presents a 12-year-old female patient with mixed comedonal/ inflammatory acne at risk for progression due to age and hormones. In pre adolescent and early adolescent acne the incompletely understood spectrum of disorders known as polycystic ovarian syndrome (PCOS). While it is important to recognize this phenotype, current treatment recommendations are not based on laboratory abnormalities but focus on a healthy diet and regular exercise.
Factors involved in pediatric acne development are similar to those of adult acne and comprise changes in the hormonal milieu, sebaceous gland hyperactivity, alterations in the skin microbiome, follicular keratinization, and proliferation of Cutibacterium acnes (C. acnes), inflammation, and genetic factors.5,6,10 Hormonal changes trigger increased sebum formation and proliferation of C. acnes, decreasing skin microbial diversity.9,25 Although the contribution of C. acnes to acne development remains unclear, C. acnes plays a role in maintaining the equilibrium of the skin’s microbiome by colonizing the lipidâ€rich sebaceous follicles.25 Testosterone and dihydrotestosterone (DHT) are important for regulating sebum production.12,13,17-19 The larger-sized sebaceous glands in acne-prone individuals are stimulated at the time of puberty.10 Although the pathology of acne is not completely understood, a pattern of innate inflammation is considered the starting point.9-11 Currently it is unclear if inflammation may be less at the forefront of preadolescent acne.9 In preadolescent acne, changes in the hormonal milieu seem more important than inflammation, including elevated insulin and IGF-1, while increasing androgen levels influence sebaceous hypersecretion and follicular hyperkeratinization.9,11-13
Typically pediatricians will handle this condition. The patient received a combination skincare regimen with nonprescription retinoid and a prescription topical. A CERs- containing foaming cream cleanser and twice daily (AM/PM) CERs-containing moisturizer were recommended for skincare.
Adolescent Acne: ≥12 to 19 Years or After Menarche For Girls
Case 8 concerns a 13-year-old female patient with mild comedonal and inflammatory acne on the chest and back. Treatment comprised a CERs-containing 4% BPO wash, adapalene plus BPO, and topical Clindamycin if needed. In addition, a CER-containing foaming cream cleanser and twice daily (AM/PM) CERs-containing moisturizer were used (Table 5).
Case 9 is a 13-year-old adolescent male patient who presents with mild acne. Treatment comprised an uncomplicated regimen with a CERs-containing 4% BPO wash and a sun protection factor (SPF)-containing moisturizer.
Case 10 presents a 13-year-old skin of color (SOC) female patient with post-inflammatory hyperpigmentation (PIH) and acne-related facial scars. Acne prevalence and sequelae are considered more common in SOC populations.26-28 Although the mechanism is not yet clear, PIH may be due to inflammationinducing excessive melanin production or irregular pigment dispersion.26-28 A study of 1942 SOC acne patients demonstrated that 43% had acne-related scarring. The study showed that most acne scars (99%) originated from inflammatory and postinflammatory acne lesions.29 Early and effective acne treatment with topical adapalene combined with BPO can prevent the risk of future scars.14,30-32
The clinician informed the patient and parents about acnerelated scarring to help the patient and parents understand why they occurred. Avoiding an abrasive scrub, rubbing the skin, and topical alcohol may prevent irritation. Gentle skincare, decreasing washing, increasing moisturizer, and sunscreen use are beneficial for richly pigmented skin.14,30-32 Pediatricians recognize the importance of PIH to acne patients and typically refer these cases to a dermatologist.5,6 The treatment of this patient comprised a nonprescription skincare regimen with lightening properties included a prescription formulation containing azelaic acid/niacinamide/BPO.33
Case 11 concerns a 14-year-old male patient with nodular and cystic acne. This common acne case presents with dry skin resulting from acne treatment with oral isotretinoin.34 Although evidence is scarce, researchers are increasingly interested in follicular epithelial barrier dysfunction in patients with acne.10,34-36 A consensus paper stated that dryness and skin irritation resulting from acne treatment could be improved using ceramidecontaining cleansers and moisturizers, enhancing treatment adherence.36 The authors stated that the skin care regimen should be an essential part of the acne prevention, treatment, and maintenance care regimen.36
Skincare is necessary for acne treatment and is part of various acne guidelines and consensus papers.5,6,14,17,22,32,34,36 Skincare comprised a CERs-containing healing ointment, moisturizer, plus SPF application in the morning after cleansing the face with a foaming wash.
Case 6
concerns a 10-year-old female patient with comedonal acne, a common pre-pubertal condition. The parents initiated the appointment with a pediatrician, and their child agreed that education and treatment might improve her skin condition. A CERs and BPO 4% containing foaming cleanser was recommended as monotherapy and maintenance.
Case 7
presents a 12-year-old female patient with mixed comedonal/ inflammatory acne at risk for progression due to age and hormones. In pre adolescent and early adolescent acne the incompletely understood spectrum of disorders known as polycystic ovarian syndrome (PCOS). While it is important to recognize this phenotype, current treatment recommendations are not based on laboratory abnormalities but focus on a healthy diet and regular exercise.
Factors involved in pediatric acne development are similar to those of adult acne and comprise changes in the hormonal milieu, sebaceous gland hyperactivity, alterations in the skin microbiome, follicular keratinization, and proliferation of Cutibacterium acnes (C. acnes), inflammation, and genetic factors.5,6,10 Hormonal changes trigger increased sebum formation and proliferation of C. acnes, decreasing skin microbial diversity.9,25 Although the contribution of C. acnes to acne development remains unclear, C. acnes plays a role in maintaining the equilibrium of the skin’s microbiome by colonizing the lipidâ€rich sebaceous follicles.25 Testosterone and dihydrotestosterone (DHT) are important for regulating sebum production.12,13,17-19 The larger-sized sebaceous glands in acne-prone individuals are stimulated at the time of puberty.10 Although the pathology of acne is not completely understood, a pattern of innate inflammation is considered the starting point.9-11 Currently it is unclear if inflammation may be less at the forefront of preadolescent acne.9 In preadolescent acne, changes in the hormonal milieu seem more important than inflammation, including elevated insulin and IGF-1, while increasing androgen levels influence sebaceous hypersecretion and follicular hyperkeratinization.9,11-13
Typically pediatricians will handle this condition. The patient received a combination skincare regimen with nonprescription retinoid and a prescription topical. A CERs- containing foaming cream cleanser and twice daily (AM/PM) CERs-containing moisturizer were recommended for skincare.
Adolescent Acne: ≥12 to 19 Years or After Menarche For Girls
Case 8 concerns a 13-year-old female patient with mild comedonal and inflammatory acne on the chest and back. Treatment comprised a CERs-containing 4% BPO wash, adapalene plus BPO, and topical Clindamycin if needed. In addition, a CER-containing foaming cream cleanser and twice daily (AM/PM) CERs-containing moisturizer were used (Table 5).
Case 9 is a 13-year-old adolescent male patient who presents with mild acne. Treatment comprised an uncomplicated regimen with a CERs-containing 4% BPO wash and a sun protection factor (SPF)-containing moisturizer.
Case 10 presents a 13-year-old skin of color (SOC) female patient with post-inflammatory hyperpigmentation (PIH) and acne-related facial scars. Acne prevalence and sequelae are considered more common in SOC populations.26-28 Although the mechanism is not yet clear, PIH may be due to inflammationinducing excessive melanin production or irregular pigment dispersion.26-28 A study of 1942 SOC acne patients demonstrated that 43% had acne-related scarring. The study showed that most acne scars (99%) originated from inflammatory and postinflammatory acne lesions.29 Early and effective acne treatment with topical adapalene combined with BPO can prevent the risk of future scars.14,30-32
The clinician informed the patient and parents about acnerelated scarring to help the patient and parents understand why they occurred. Avoiding an abrasive scrub, rubbing the skin, and topical alcohol may prevent irritation. Gentle skincare, decreasing washing, increasing moisturizer, and sunscreen use are beneficial for richly pigmented skin.14,30-32 Pediatricians recognize the importance of PIH to acne patients and typically refer these cases to a dermatologist.5,6 The treatment of this patient comprised a nonprescription skincare regimen with lightening properties included a prescription formulation containing azelaic acid/niacinamide/BPO.33
Case 11 concerns a 14-year-old male patient with nodular and cystic acne. This common acne case presents with dry skin resulting from acne treatment with oral isotretinoin.34 Although evidence is scarce, researchers are increasingly interested in follicular epithelial barrier dysfunction in patients with acne.10,34-36 A consensus paper stated that dryness and skin irritation resulting from acne treatment could be improved using ceramidecontaining cleansers and moisturizers, enhancing treatment adherence.36 The authors stated that the skin care regimen should be an essential part of the acne prevention, treatment, and maintenance care regimen.36
Skincare is necessary for acne treatment and is part of various acne guidelines and consensus papers.5,6,14,17,22,32,34,36 Skincare comprised a CERs-containing healing ointment, moisturizer, plus SPF application in the morning after cleansing the face with a foaming wash.
