The first detailed, evidence-based clinical guidelines for the treatment of acne in children and teens was issued by The American Acne and Rosacea Society. The guidelines, which were endorsed by the American Academy of Pediatrics, were released in the May issue of the journal Pediatrics.
Until now, acknowledged guidelines for the diagnosis and management of pediatric acne were lacking. But, with acne occurring at younger ages (one study found that more than three-quarters of 9 and 10 year old girls had acne), developing a protocol that addresses safety and treatment concerns was required.
“The guidelines are based on sound evidence and represent the best practices for dealing with acne “
Given that the development of acne appears to be the same for adults, teens and children, the same principles and therapeutic agents apply to all age groups diagnosed with acne. However, in children and adolescents, considerations such as ease of use, patient adherence, cost factors and adverse effects on young skin determines the use of these agents.
In addition to categorizing pediatric acne, the panel looked at a wide variety of treatments including the use of over-the-counter (OTC) products, topical benzoyl peroxide (BP), topical retinoids (Retin-A, Avita, Differin), topical antibiotics, oral antibiotics, hormonal therapy and isotretinoin (Roaccutane, know previously as Accutane, Claravis). Products that contain a fixed-dose of combination products were also reviewed (e.g., BP/clindamycin, BP/adapalene, tretinoin/clindamycin).
The panel’s recommendations were based on using an approach that uses the least aggressive regimen that is effective while avoiding regimens that encourage bacterial resistance. A treatment recommendation was made for mild, moderate and severe acne.
As a first line of defense, the panel recommended benzoyl peroxide containing products as this ingredient is the best-studied and is a common ingredient in OTC acne products.
In young patients with more difficult acne, adding topical retinoids is a good next step. Oral antibiotics can also be added to the regimen in the case of moderate to severe acne. But, with increased antibiotic resistance, the authors urged appropriate use of antibiotics. Hormonal therapy should also be considered in women.
Due to its efficacy, the panel recommended use of isotretinoin (brand names include Roaccutane formerly known as Accutane) in the case of severe, scarring acne but recommended careful monitoring due to its side-effects and toxicities.
Lawrence Eichenfield, the lead author of the report, said that it’s important to dispel kids’ and sometimes parents’ acne myths. “Acne is not caused by dirt or poor hygiene,” Eichenfield said. The group recommended using a mild cleanser twice a day but cautioned against over cleansing. They suggested going easy on toner as these products can cause irritation.
In addition to reviewing acne treatments, the panel looked at studies examining the relationship between diet and acne. The panel did not provide any dietary recommendations but acknowledged several studies including work done by Loren Cordain, PhD indicating the role of sugary foods and dairy in promoting acne development.
The Bottom Line
The good news is that many treatment options are available and children don’t have to live with acne that is troubling to them. But, these treatments are now without their side-effects. Fortunately, for products containing benzoyl peroxide or retinoids, the main issue is dry skin or irritation. Antibiotics, which are routinely prescribed for acne, are more problematic. These medications kill beneficial gut bacteria which often leads to digestive upset and yeast overgrowth in women.
Perhaps a larger concern is why are younger kids getting acne? One theory is because kids are starting puberty earlier than in past generations. And, environment – from junk food to lack of exercise to chemicals – may be playing a role in accelerating puberty.
For this reason, I think it’s especially important to address the nutritional aspects of acne. The vast majority of kids do not eat a health-promoting diet. By improving their diet at a young age, the result may be not only a clearer complexion, but the establishment of healthy habits that will last for a lifetime.
David H. Rahm, M.D. is the founder and medical director of The Wellness Center, a medical clinic located in Long Beach, CA. Dr. Rahm is also president and medical director of VitaMedica. Dr. Rahm is one of a select group of conventional medical doctors who have education and expertise in functional medicine and nutritional science. Over the past 20 years, Dr. Rahm has published articles in the plastic surgery literature and educated physicians about the importance of good peri-operative nutrition.