Acne vulgaris in Child
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Synopsis
Acne vulgaris is an extremely common, usually self-limited, chronic inflammatory condition of the pilosebaceous unit. The pathogenesis involves multiple factors, including (1) increased sebum production, (2) follicular hyperkeratinization and corneocyte hypercohesiveness, (3) proliferation of the bacterium Cutibacterium acnes (formerly known as Propionibacterium acnes), and (4) inflammation that is neutrophil-driven in early lesions and Th1/Th17 driven in established lesions. Acne vulgaris typically begins at puberty as a result of androgen stimulation of the pilosebaceous unit and changes in the keratinization at the follicular orifice.
There is a wide spectrum of clinical disease, ranging from a few comedones to many inflamed papules, pustules, and nodules. Acne can be classified as being mild, moderate, or severe, but this designation may vary between clinicians as there is no single grading system that has been adopted by all.
Acne vulgaris is most commonly diagnosed among the adolescent patient population. It is most commonly found on areas of skin with the greatest density of sebaceous follicles, such as the face, back, and upper chest. Acne can affect people of every race and ethnicity. Acne can last through the teenage years into adulthood. Some studies report that acne vulgaris is slightly more common in adolescent females than in their adolescent male counterparts. Patients with endocrinopathies producing hyperandrogenic states (ie, HAIR-AN syndrome, polycystic ovary syndrome [PCOS]) and hypercorticism (ie, Cushing syndrome, ectopic ACTH syndrome, congenital adrenal hyperplasia) also present with an increased risk of developing acne. While a benign condition, acne can lead to permanent scarring and disfigurement and has been associated with significant psychosocial distress, such as anxiety and depression. Therefore, initiation of treatment in the earliest stages is preferable. Infantile acne is associated with a higher risk of developing severe acne during adolescence.
A number of medications have been reported to cause acne vulgaris or an acneiform eruption. Most commonly, this is seen in patients who have received systemic corticosteroids or are using topical corticosteroids, or individuals using anabolic steroids (see steroid acne). Acneiform eruptions also have been reported in patients treated with cetuximab, gefitinib, and erlotinib (see EGFR inhibitor-induced papulopustular eruption), danazol, stanozolol, testosterone, lithium, quetiapine, iodides, bromides, isoniazid, phenytoin, cyclosporine, granulocyte-colony stimulating factor (G-CSF), medroxyprogesterone, low-estrogen oral contraceptives, progesterone-only birth control, phenobarbital, propylthiouracil, and vitamins B2, B6, and B12. While the onset of the eruption varies among the different agents, it typically occurs within 1-2 weeks of initiating systemic corticosteroid therapy. JAK inhibitors (JAKi) have also been shown to induce acne and acneiform eruptions, as well as exacerbate underlying acne.
Related topics: acne conglobata, acne excoriée, acne fulminans, acne mechanica, acne necrotica, cosmetic-induced acne
Codes
ICD10CM:L70.0 – Acne vulgaris
SNOMEDCT:
88616000 – Acne vulgaris
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Perioral dermatitis
- Pomade acne
- Cosmetic-induced acne
- Steroid acne
- Acne conglobata
- Milia
- Folliculitis
- Pityrosporum folliculitis
- Eosinophilic pustular folliculitis
- Demodex folliculitis
- Flat warts
- Molluscum contagiosum
- Syringomas
- Disseminated histoplasmosis, disseminated cryptococcosis, disseminated coccidioidomycosis, iododerma, and bromoderma may all present as an acneiform eruption.
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:10/31/2022
Last Updated:11/06/2022
Last Updated:11/06/2022
Patient Information for Acne vulgaris in Child
Overview
Acne, also known as acne vulgaris, is a common skin condition that can affect people of all ages, including children.Acne is often hereditary, meaning it runs in families. While there is no cure for acne, almost all acne can be improved by simple measures and treatments your child's doctor can recommend.
There is no cure for acne, but certain steps can help prevent more breakouts. Acne can result in scarring, so minimizing breakouts is important.
Who’s At Risk
Acne affects 85%-100% of people at some point in their lives. While it usually begins at puberty, it can start even earlier. Acne is uncommon in children younger than 8 years, but it can occur because of a hormonal imbalance and certain medications. People of all races / ethnicities get acne.Signs & Symptoms
Acne most commonly occurs on the face, neck, chest, and back, where the most sebaceous glands are located. Acne lesions can be blackheads (open comedones), whiteheads (closed comedones), papules, pustules, and nodules / cysts. Papules are small, smooth, solid bumps that may be pink or red in lighter skin colors or darker red, maroon, or brown in darker skin colors. Pustules are pus-filled lesions, and nodules and cysts are larger and deeper than papules.Mild acne consists of a few papules / pustules and sometimes comedones. Moderate acne has an increased number of these lesions. Severe acne has numerous comedones, papules, pustules, and may have painful nodules and cysts.
Acne can result in permanent scars, which can appear to be depressions in the skin or hyperpigmentation, which appears as brown, flat marks where the acne lesions were. This skin color change may be more pronounced or last longer in darker skin.
Self-Care Guidelines
If your child has a hormonal imbalance, treating it will help resolve the acne lesions.Cleanse the acne-prone areas with gentle soaps or cleansers. Avoid irritants such as rubbing and other alcohols, abrasive scrubs, and greasy products on the skin and the scalp. Products labeled "water-based" or "noncomedogenic" will help reduce clogged pores.
There are also a variety of over-the-counter medications that may help. These are meant to be preventive therapies and should be applied in a thin layer to the entire area on a regular basis. If applied consistently, you may see small improvements quickly, but results are generally seen after a few months. Children have sensitive skin and may experience very drying side effects from these medications. For drier skin, use a weaker concentration of benzoyl peroxide; for oily skin, consider higher strengths. Be careful, as benzoyl peroxide can bleach clothing and towels. Peeling agents (exfoliants), such as salicylic acid, can also help.
When to Seek Medical Care
Children younger than 8 years with acne should be seen by their health provider to investigate its causes, such as a hormone imbalance or a medication side effect.If your child is 8 years or older and has moderate or severe acne that has not improved effectively with self-care, seek medical help.
Treatments
If your child has not reached puberty, blood tests might be done to look for a hormone imbalance.Topical treatments include creams, washes, or gels, such as:
- Antibacterial agents such as clindamycin (Cleocin T), erythromycin (AkneMycin), sulfur, sodium sulfacetamide (Liquimat, Sulpho-Lac), dapsone (Aczone) in children ages 9 years and older, and azelaic acid (Azelex, Finacea) in children ages 12 years and older.
- Retinoids – vitamin A-based products such as tretinoin (Retin-A), tazarotene (Avage, Tazorac), and adapalene (Differin).
Acne vulgaris in Child