Overview
Acne in children has been classified into different age groups by the American Acne and Rosacea Society. These classifications include neonatal acne, infantile acne, mid-childhood acne, and preadolescent acne.
Neonatal Acne
Occurs from birth to 6 weeks of age, affecting about 20% of newborns. It presents as comedones (whiteheads and blackheads) on the scalp, upper chest, and back, along with inflammatory lesions (erythematous papules and pustules) on the cheeks, chin, and forehead. Neonatal acne rarely results in scarring and affects boys more than girls at a ratio of 5:1.
Infantile Acne
Appears between 6 weeks to 1 year of age and is less common. It presents with comedones, papules, pustules, and occasional nodules, primarily affecting the cheeks. In rare cases, it may persist until puberty but is not linked to endocrine abnormalities. It affects boys more than girls at a ratio of 3:1.
Mid-childhood Acne
Very rare, occurring in children aged 1–6 years. An endocrinologist should be consulted to exclude possible hyperandrogenism if acne appears in this age group.
Preadolescent Acne
Commonly seen in children aged 7–12 years (or up to menarche in females). Acne can be the first sign of puberty and typically presents as comedones in the T-zone (forehead, nose, and chin).
What is Acne?
Acne is a disorder of the hair follicles and sebaceous glands. Hair follicles are the structures around the base of each hair, while sebaceous glands release oil (sebum) into the hair follicles, which helps to moisten the skin and hair. Acne occurs when these pores become clogged with dead skin cells and oil, often involving bacteria that normally live on the skin.
Causes
What Causes Acne?
The precise cause of acne is not fully understood, but several factors are associated with its development:
Hormonal Changes
Hormonal fluctuations during puberty, pregnancy, and the menstrual cycle can trigger acne. Rising levels of androgens in both boys and girls during puberty increase sebum production and skin cell turnover, leading to clogged pores.
Cosmetics and Skincare Products
Products that block pores can exacerbate acne.
Environmental Factors
High humidity, sweating, and wearing clothing that rubs or irritates the skin can contribute.
Medications
Certain medications, such as corticosteroids, can cause or worsen acne.
Acne in Children
In children, acne can be influenced by additional factors:
Neonatal Acne
Likely results from hyperactive sebaceous glands responding to neonatal and maternal androgens. Androgen levels decrease after about 1 year but increase again around 7 years of age with the onset of adrenarche.
Infantile Acne
May be linked to higher levels of androgens in males during early childhood, resulting in increased sebum production and subsequent acne.
Symptoms of Acne in children
Acne can appear anywhere on the body but is most common in areas with more sebaceous glands, such as the face, chest, upper back, shoulders, and neck. Symptoms can vary but generally include:
Comedones
Small bumps that are either skin-colored or white (whiteheads) or dark in color (blackheads).
Inflamed Acne
Red, pus-filled pimples (pustules) that may be painful.
Papules
Small, raised bumps that are inflamed but do not contain pus.
Nodules
Larger, solid bumps that are deeper in the skin and can be painful.
Cysts
Deep, pus-filled nodules that can lead to scarring (Stanford Medicine, 2023).
Acne in Children
In children, the symptoms of acne can include:
Neonatal Acne
Comedones and inflammatory lesions on the cheeks, chin, and forehead.
Infantile Acne
Comedones, papules, pustules, and nodules primarily on the cheeks.
Mid-childhood Acne
Rare, but may present similarly to infantile acne.
Preadolescent Acne
Comedones in the T-zone, often as an early sign of puberty.
How is Acne Diagnosed?
Diagnosis of acne typically involves a physical examination and a review of the patient’s medical history. In some cases, additional tests may be recommended:
Clinical Examination
The healthcare provider will assess the type and severity of acne and may ask about factors such as skincare routines, cosmetics use, and family history.
Hormonal Tests
In pre-pubertal children with severe or persistent acne, hormone levels such as free and total testosterone, dehydroepiandrosterone, luteinizing hormone, follicle-stimulating hormone, prolactin, and 17-hydroxyprogesterone may be measured to rule out underlying endocrine issues.
Treatment for Acne
The goal of acne treatment is to improve the skin’s appearance and prevent scarring. Treatment options vary depending on the severity of the condition and the patient’s age and general health.
General Skincare
Gentle, regular skin care is essential. This includes washing the skin twice daily with a mild cleanser and avoiding greasy or comedogenic products.
Topical Treatments
These include creams, gels, lotions, or liquids applied directly to the skin, such as:
- Benzoyl Peroxide: An antiseptic that kills bacteria and reduces inflammation.
- Topical Antibiotics: Help reduce bacteria and inflammation.
- Topical Retinoids: Derived from vitamin A, these help prevent the formation of new comedones and promote cell turnover.
Oral Medications
These may be prescribed for moderate to severe acne, including:
- Antibiotics: Such as tetracycline, doxycycline, or erythromycin to reduce bacteria and inflammation.
- Isotretinoin: For severe acne that is unresponsive to other treatments. It helps reduce sebum production and prevent scarring.
Procedures
In some cases, procedures such as laser therapy, light therapy, chemical peels, or drainage of cysts may be recommended.
Specific Treatments for Children
In children, the treatment approach is generally similar to that for adults, with some age-related modifications:
Mild Acne
Managed with gentle skincare, benzoyl peroxide, and topical retinoids. Lower concentrations of benzoyl peroxide may be used to reduce irritation.
Moderate Acne
Treated with oral antibiotics such as erythromycin, combined with topical treatments. Doxycycline and minocycline are used only in children over 12 years of age.
Severe Acne
May require isotretinoin if oral antibiotics are ineffective. Deep nodules can be treated with intralesional corticosteroid injections.
Possible Complications of Acne
Acne can lead to several complications, including:
Scarring
Severe or long-term acne can result in permanent scarring.
Emotional Impact
Acne can significantly affect self-esteem, leading to emotional problems such as depression, anxiety, and even suicidal thoughts.
Infections
Secondary bacterial infections can occur if acne lesions are picked or scratched.
Helping a Child Live with Acne
Living with acne can be challenging, but early and effective treatment can help prevent severe acne and its complications. Parents can support their child by:
Encouraging Proper Skincare
Remind the child to gently wash their face and avoid picking or squeezing acne lesions.
Seeking Professional Help
Consult a dermatologist if over-the-counter treatments are ineffective.
Monitoring Emotional Well-being
Be aware of the child’s emotional response to acne and seek counseling if necessary.
Following a Treatment Plan
Ensure the child follows the prescribed treatment regimen and continues maintenance therapy as needed to prevent recurrence.
References
American Acne and Rosacea Society. (n.d.). National pediatric acne treatment guidelines. Retrieved March 9, 2025, from https://acneandrosacea.org/national-pediatric-acne-treatment-guidelines
DermNet NZ. (n.d.). Acne in children. Retrieved March 9, 2025, from https://dermnetnz.org/topics/acne-in-children
Stanford Medicine. (n.d.). Acne: Overview, symptoms, diagnosis, and treatment. Retrieved March 9, 2025, from https://stanfordhealthcare.org/medical-conditions/skin-hair-and-nails/acne.html
Johns Hopkins Medicine. (n.d.). Acne. Retrieved March 9, 2025, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/acne
