May 15, 2013
Recommendations Spell Out Acne Treatment for
Children, Infants

Elk Grove Village, IL—Acne isn’t just for teenagers.

Pharmacists and other health professionals know that, but specific recommendations on how to treat the condition in younger children have been lacking.

Now, new recommendations by the American Acne and Rosacea Society—reviewed and endorsed by the American Academy of Pediatrics—provide the first detailed, evidence-based clinical guidelines for age-appropriate management of pediatric acne.

The report notes that acne vulgaris is one of the most common skin conditions in both children and adolescents, pointing out that even 20% of newborns have the condition.

Age-related guidelines treatment include that for neonates, acne pustules on the face and upper body should be treated with 2% ketoconazole cream, and, in infants up to 12 months, treatment for acne—which is more common in boys—can include topical antimicrobials, topical retinoids, noncycline antibiotics (erythromycin), and, sometimes, isotretinoin. The guidelines caution that none of the medications are indicated by the FDA for use in this age group.

Acne often can be treated with OTC remedies, according to guideline authors who called benzoyl peroxide "somewhat effective" for mild acne. They note that salicylic acid appears to be less useful than benzoyl peroxide.

“Antibacterial washes, other than [benzoyl peroxide], have not been shown to be useful in the treatment of acne,” the paper stated. “Benzoyl peroxide has been shown to be the most widely studied of [OTC] products and has been shown to be one of the most versatile, safe, inexpensive and effective acne therapies.”

Pharmacists and other health care professionals should warn against the use of harsh cleaners, which can make the condition worse, and should reassure children that their acne is unlikely to be caused by poor hygiene or use of cosmetics, according to the guidelines.

The report, published recently in the journal Pediatrics, also provides a review of other possible therapies, including:

• Topical retinoids are safe in young people 12 and older, with tretinoin gel 0.05% FDA-approved for children 10 and older. Other alternative treatments that can be safely used include adapalene and tazarotene.
• Monotherapy with topical antibiotics such as clindamycin and erythromycin is not recommended because of their slow action as well as the risk of developing resistance. Instead, the authors recommend that topical benzoyl peroxide be used with topical antibiotics in treatments longer than a few weeks.
• Although oral antibiotics have been used for treating moderate acne for 50 years, most—extended-release minocycline being an exception—are not FDA approved for that indication, the authors note, pointing out that commonly prescribed oral antibiotics for children 8 and older are tetracycline, doxycycline, and minocycline.
• The recommendations warn, however, that the tetracycline class, including minocycline, should not be prescribed for children who have not yet developed permanent teeth.
• Topical dapsone, a synthetic sulfone, has been shown effective as a microbial and anti-inflammatory, according to the authors.
• In treatment for severe acne, oral isotretinoin typically produces “excellent results,” but can have significant adverse effects, including skeletal concerns, potential risks for inflammatory bowel disease, and mood changes, such as depression and suicidal ideation, the recommendations caution.
• Hormonal therapy with combined oral contraceptives “may be useful as second-line therapy” for girls with moderate to severe acne, the authors add.

The recommendations were developed to fill a gap according to the authors, who note, “The presentation, differential diagnosis, and association of acne with systemic pathology differs by age of presentation. Current acknowledged guidelines for the diagnosis and management of pediatric acne are lacking, and there are variations in management across the spectrum of primary and specialty care.”

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