New guidelines for treatment of pediatric acne

Just-published expert recommendations from the American Acne and Rosacea Society (AARS) are the first evidence-based clinical guidelines for the management of acne vulgaris in children and adolescents.

There has been little published evidence regarding the safety and efficacy of acne medications for pediatric patients, especially for preadolescents. Under the auspices of the AARS, a panel of pediatric dermatologists, pediatricians, and dermatologists with expertise in acne was charged with developing recommendations for the management of pediatric acne and creating evidence-based treatment algorithms for children and adolescents.

The guidelines categorize pediatric acne by age: neonatal, birth to 6 weeks; infantile, 6 weeks to 1 year; mid-childhood, 1 year to 7 years; preadolescent, 7 years to 12 years or menarche in girls; and adolescent, 12 to 19 years or after menarche in girls. Treatment is based on age and physical findings, including type and distribution of acne lesions; height; weight; growth curve; and blood pressure abnormalities. Patients with signs of precocious sexual maturation or virilization should be referred to a pediatric endocrinologist.

In general, treatment for pediatric acne vulgaris is similar to treatment for older adolescents and adults and is based on acne pathophysiology and severity. The therapeutic objective is to treat as many age-appropriate pathogenic factors as possible by reducing sebum production, preventing the formation of microcomedones, suppressing Propionibacterium acnes, and reducing inflammation to prevent scarring. Treatments are single-regimen or combination therapies determined by the treatment algorithm and consist of over-the-counter products, topical benzoyl peroxide, topical retinoids, topical and oral antibiotics, hormonal therapy, and isotretinoin.

In most cases, acne can be successfully treated by primary care physicians with referrals to pediatric dermatologists or pediatric endocrinologists when appropriate. The guidelines recommend that both patients and parents be counseled about what acne is and how treatments work to control it, and be given reasonable expectations about what therapy can achieve.

The AARS guidelines are endorsed by the American Academy of Pediatrics.