MONDAY, May 6 (HealthDay News) -- Pimples have long been the
bane of teenage existence, but pediatricians say there is now
enough evidence on effective treatments to put out the first
guidelines on battling acne in children.
There is a range of medications that can clear up even severe
cases of acne, according to the American Academy of Pediatrics
(AAP). Writing in the May issue of its journal
Pediatrics, the group throws its support behind new
guidelines from the American Acne and Rosacea Society that detail
how to treat acne in children and teens of all ages.
That "all ages" part is important because acne is becoming more
and more common in pre-teens, too, said Dr. Lawrence Eichenfield,
the lead author of the AAP report. One study of 9- and 10-year-old
girls found that more than three-quarters had pimples.
It's thought that it may be because boys and girls are, on
average, starting puberty earlier compared with past generations,
said Eichenfield, a pediatric dermatologist at Rady Children's
Hospital in San Diego.
According to the AAP, mild acne often can be tackled with
over-the-counter fixes. Washes, lotions and other products
containing benzoyl peroxide are the best studied, and the best
place to start, the group said.
"It's a pretty effective agent, especially for mild acne," Eichenfield said. Benzoyl peroxide is also the most common ingredient in over-the-counter acne fighters. Another common one is salicylic acid, but there has not been much research on it. When it has been tested head-to-head against benzoyl peroxide, Eichenfield said, the latter has won out.
If over-the-counter products do not do the job, the next step
could be topical retinoids -- prescription medications like
Retin-A, Avita and Differin. They are vitamin A derivatives and
work by speeding up skin cell turnover, which helps unclog
The main side effects of all the topical treatments are skin
irritation and dryness, the AAP said.
If the acne is moderate to severe, oral antibiotics could be
added to the mix because bacteria that live on the skin play a role
in acne. When pores become clogged with oil and skin cells,
bacteria can grow in the pore and cause inflammation. Antibiotics
help by killing bacteria and soothing inflammation.
But, Eichenfield said, "it's important to use antibiotics
appropriately." One reason is because acne-causing bacteria have
become less sensitive to common antibiotics in the past couple
decades, due to widespread use of the drugs.
Another is that antibiotics can have side effects, such as
stomach upset, dizziness and, in girls, yeast infections.
When acne is severe and other treatments have failed, the AAP
said, doctors and parents might consider the prescription drug
isotretinoin -- brand-names including Roaccutane (formerly known as
Accutane) and Claravis.
The drug is very effective, but it can cause birth defects, so
girls and women have to use birth control and get regular pregnancy
tests if they go on the medication. Isotretinoin also has been
linked to inflammatory bowel disease, depression and suicidal
thoughts in some users -- although it's not clear the drug is to
blame, the AAP said. (Severe acne itself can cause depression and
suicidal thoughts, for example.)
Dr. David Pariser, a dermatologist not involved in the
recommendations, said they are "based on sound evidence" and
reflect the "best practices" in battling acne.
When should parents consider taking their child to a doctor for
acne treatment? It depends on how severe the problem is, and how
bothered the child is, said Pariser, who sits on the board of
directors of the American Academy of Dermatology.
Some kids can deal with skin eruptions, but Pariser said he sees
others who refuse to leave the house.
Both he and Eichenfield said it's important to dispel kids' (and
sometimes parents') acne myths. "Acne is not caused by dirt or poor
hygiene," Eichenfield said, and harshly scrubbing your face will
probably make the situation worse.
It's best to wash your face gently twice a day, with a soap-free
pH-balanced cleanser, the AAP said. Facial toners -- which commonly
come in pre-packaged acne regimens -- can help clear away oil. But
the group suggested going easy on toners, since they can irritate
And what about food? "The medical community has swung back and
forth on that over the years," Pariser said. Years ago, people
thought that certain foods, like chocolate, sugar and iodine,
promoted breakouts, but studies starting in the late 1960s failed
to confirm that.
"The idea that food plays a role became relegated to myth," Eichenfield said. But recently, he added, some researchers have been revisiting the issue. There is some evidence that a sugary diet may promote acne, for example. But for now, it's not clear whether any diet changes will actually help keep kids' skin clear, Eichenfield said.
The bottom line, he said, is that many treatment options are
available. "There's no reason that children have to live with acne
that is severe and troubling to them," he said.
Learn more about
acnefrom the U.S. National Institute of Arthritis
and Musculoskeletal and Skin Diseases.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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