New Acne Treatment for Kids, How Does It Work?
The vast majority of teenagers experience some degree of acne, but this skin disease can affect younger people as well. That’s one reason why the American Acne and Rosacea Society has issued new recommendations regarding acne treatment for kids, including infants and elementary school aged children, because not all kids should be treated alike.
Do you know how to treat your child’s acne?
Several new studies indicate that acne is not just for teenagers. In fact, according to Lawrence Eichenfield, MD, of Rady’s Children’s Hospital in San Diego, and his colleagues, more than three-quarters of girls ages 9 and 10 had acne in one study, and 20 percent of newborns have the skin disease as well.
In another new study published in FP Essentials, investigators at San Joaquin General Hospital in California report that both neonatal acne and infantile acne (which starts after the neonatal period) typically develops on the face, scalp, back, and chest and usually goes away spontaneously. If either type of acne does not resolve within a year, children should be evaluated for excessive levels of androgens (male hormones).
According to the new guidelines announced by the American Acne and Rosacea Society, which have been endorsed by the American Academy of Pediatrics, each age group requires a different treatment approach. For example:
- Newborns with acne on the face and upper body should be treated with 2 percent ketoconazole cream. Ketoconazole is associated with side effects that include itching, irritation, dry skin, and stinging. Infants who have significant acne should be checked for tumors, diseases that affect the endocrine system, and sex hormone abnormalities.
- Infants up to age 12 months can be treated with topical antimicrobials or retinoids, noncycline antibiotics (e.g., erythromycin), and isotretinoin. Use of all these medications is off-label, meaning they are not indicated for this purpose for this age group. Topical retinoids have been approved for children ages 12 and older, while tretinoin gel 0.05% in particular has approval from the Food and Drug Administration (FDA) for children age 10 years and older.
- Among children up to age seven, acne is usually absent, so if it does appear, it suggests an endocrine problem, which should be checked.
- In children up to the age of puberty, the development of acne on the face may be the first sign of this change in life. If the acne is severe, clinicians should check for polycystic ovary syndrome (in females) or other endocrine abnormalities.
Children with mild acne may respond to benzoyl peroxide, which the authors of the guidelines noted “has been shown to be the most widely studied of [over-the-counter] products and has been shown to be one of the most versatile, safe, inexpensive and effective acne therapies.” The guidelines are based on an analysis of more than 150 acne-related studies.
Topical benzoyl peroxide should not be used alone, however, and the authors stated that topical antibiotics (e.g., clindamycin, erythromycin) should be added when acne treatment is necessary for more than several weeks. Other treatment recommendations for children included the following:
- Oral antibiotics can be added to topical treatments in children who have moderate acne. Children age 8 and older may take doxycycline, minocycline, or tetracycline.
- Children who have not yet developed their permanent teeth should not take oral antibiotics in the tetracycline class because they can permanently stain the teeth
- Topical dapsone, an antibacterial agent, is typically used for mild to moderate acne and helps reduce inflammatory lesions. It has FDA approval for children older than 12.
- Children with severe acne may be treated with oral isotretinoin, although the drug is associated with serious side effects such as risk of inflammatory bowel disease, mood changes, and bone problems
- The addition of combination oral contraceptives as a second line of treatment may be helpful in females who have moderate to severe acne
Diet and herbs for acne
The role of diet in acne is still uncertain, although the authors pointed out that a low-glycemic diet resulted in a significant reduction in acne lesions in one study. In that review, the investigators reported that medical nutritional therapy appears to have an important role in treating acne.
According to Jennifer Burris, MS, RD, at New York University and one of the study’s authors, “dermatologists and registered dietitians have revisited the diet-acne relationship and become increasingly interested in the role of medical nutritional therapy in acne treatment.” Overall, the reviewers found that dairy products and foods with a high glycemic load appear to be especially associated with acne.
Turning to the natural world, some research indicates that herbs such as thyme may be an effective acne treatment. Investigators from Leeds Metropolitan University found that tinctures of thyme, marigold, and myrrh killed the bacteria associated with acne (Propionibacterium acnes) within five minutes, and that thyme was the most effective, even better than benzoyl peroxide.
Use of thyme as an acne treatment is still being explored by researchers, as are other options. Another treatment under investigation is the use of coconut oil nano-bombs, which utilize nanotechnology to attack acne.
Acne can appear anytime during a child’s life, from birth through the teenage years. It’s important for parents and clinicians to realize that acne treatment can differ for children depending on their age.
Burris J et al. Acne: the role of medical nutrition therapy. Journal of the Academy of Nutrition and Dietetics 2013; 113(3): 416
Eichenfield L et al. Evidence-based recommendations for the diagnosis and treatment of pediatric acne. Pediatrics 2013; doi:10.1542/peds.2013-0490B
Zuniga R, Nguyen T. Skin conditions: common skin rashes in infants. FP Essentials 2013 Apr; 407:31-41