The American Academy of Pediatrics has endorsed new guidelines issued by the American Acne and Rosacea Society on the management of pediatric acne. The guidelines are published in a supplement available online May 1 in Pediatrics.
"The presentation, differential diagnosis, and association of acne with systemic pathology [differ] by age of presentation," write Lawrence F. Eichenfield, MD, from pediatric and adolescent dermatology at Rady Children's Hospital in San Diego, California, and colleagues. "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. The American Acne and Rosacea Society convened a panel of pediatric dermatologists, pediatricians, and dermatologists with expertise in acne to develop recommendations for the management of pediatric acne and evidence-based treatment algorithms."
The expert panel identified 10 topics, each of which was assigned to 2 expert reviewers. The panel searched and reviewed available literature, used the Strength of Recommendation Taxonomy for the consensus recommendations, and developed algorithms based on age and pubertal status (adolescent, preadolescent, infantile, and neonatal).
Available treatments include over-the-counter products; topical benzoyl peroxide (BP), retinoids, and antibiotics; and oral antibiotics, hormonal therapy, and isotretinoin. Other topics discussed in the guidelines include the psychosocial effects of acne, adherence to treatment regimens, the role of diet, and consultation with a pediatric dermatologist or endocrinologist when appropriate.
BP is safe and effective as monotherapy or in topical combination products for mild acne or in regimens for acne of all types and severities.
When used with topical or systemic antibiotics, BP may minimize development of antibiotic-resistant Propionibacterium acnes.
For all types and severities of acne in children and adolescents of all ages, topical retinoids may be used as monotherapy or in combination products and regimens.
Because of the slow onset of action and development of antibiotic resistance, topical antibiotics are not recommended as monotherapy. Topical BP should be added if topical antibiotics are needed for more than a few weeks.
For moderate-to-severe inflammatory acne vulgaris at any age, oral antibiotics are appropriate, but tetracycline derivatives (tetracycline, doxycycline, and minocycline) should not be used in children younger than 8 years.
Compared with tetracycline, doxycycline and minocycline are easier to use, can be taken with food, and require less-frequent dosing.
Patients should be warned and followed-up for possible adverse effects of oral antibiotics.
Isotretinoin is recommended for severe, scarring, and/or refractory acne in adolescents and may be used in younger patients, with counseling to avoid pregnancy and with monitoring of potential adverse events.
Regimens incorporating fixed-dose combination topical therapies may be helpful for all types and severities of acne.
For pubertal females with moderate to severe acne, hormonal therapy with combined oral contraceptives may be useful as second-line therapy in regimens of care. Many experts recommend delaying oral contraceptives for acne not associated with endocrinologic pathology until 1 year after menses begin.
"As the pathogenesis of acne vulgaris appears to be similar at all ages, the same principles and therapeutic agents apply to all age groups diagnosed with acne," the guidelines authors conclude. "However, age group differences may require special considerations in the use of these agents, particularly with regard to ease of use and patient adherence, cost factors, differences in psychosocial impacts among age groups, the likelihood of scarring, and the use of advanced vehicles to minimize adverse effects on young skin."
The American Acne and Rosacea Society, a nonprofit organization, received educational grant funding for this article from annual corporate benefactors, including Galderma Laboratories, Medicis Pharmaceuticals, Ortho Dermatologics, and Valeant Pharmaceuticals. The guidelines authors received compensation from the American Acne and Rosacea Society for participation in the consensus conference resulting in guidelines development. Physician Resources, LLC provided editorial and research assistance throughout the process.
By Laurie Barclay, MD
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