TUESDAY, Aug. 6 (HealthDay News) -- Though acne has long been
viewed as a teen phenomenon, dermatologists have been tending to an
ever-younger patient pool, a new preadolescent reality that many
experts link to a trend toward an earlier onset of puberty.
Now, a team of physicians has put together a new list of
treatment recommendations that they hope will lead to a better
age-appropriate standard of care for children as young as 7.
The guidelines address issues such as when over-the-counter
creams should be used versus prescription medicines (including
antibiotics, retinoids and, for girls in some cases, hormone
therapy). They also discuss how to help young patients stick with
their treatments and deal with the emotional effects of acne.
"As the initial start of puberty is occurring earlier than in the past, we needed to define the age ranges and concerns regarding the different groups that make up pediatric acne," said guideline co-author Dr. Andrea Zaenglein, a pediatric dermatologist and professor of dermatology and pediatrics at Penn State/Hershey Medical Center.
She said the goal is "to provide pediatricians and anyone who
cares for children with acne with specific guidelines for the care
of their patients."
Zaenglein and her colleagues presented their recommendations,
which have been endorsed by the American Academy of Pediatrics and
Pediatrics, at the recent American Academy of Dermatology
annual meeting in New York City.
The team defines preadolescent acne as cases occurring among
children aged 7 to 12.
The guideline authors pointed out that preadolescent acne is not
usually a cause for undue alarm, typically involving the onset of
whiteheads and blackheads in the forehead, nose and chin region.
More serious inflammatory lesions are not commonly seen among these
younger patients, and scarring -- though a concern -- is rare.
The new recommendations advise doctors to first treat cases of
preadolescent mild acne with over-the-counter benzoyl peroxide.
Only when such products fail to do the trick -- or when children
are afflicted with larger-than-usual acne zones -- are
age-appropriate oral antibiotics or retinoids to be added to the
Children should also be instructed to adopt good cleansing
protocols, such as washing acne-prone areas twice daily with a
nonabrasive pH-balanced cleanser.
Consistent monitoring alongside treatment is also suggested even
once acne is brought under control, as the onset of preadolescent
acne can be an early sign of more serious acne problems as a child
ages into a teen and young adult.
While acknowledging the need to identify the problem and seek
appropriate treatment, Zaenglein stressed that "it is important
that parents do not panic" because preadolescent acne is readily
"Acne is very unlikely to be a sign of a hormonal abnormality in that age range," she said, "although your doctor should confirm with a thorough history and physical exam."
But what explains the preadolescent acne phenomenon in the first
The jury is still out, said Dr. Lawrence Eichenfield, chief of
pediatric and adolescent dermatology at the University of
California, San Diego (UCSD), and himself a member of the guideline
"There are many ideas as to why this is happening," he said. "It is true that while back in the 1990s it was not that uncommon to see the onset of puberty among 8- or 9-year-olds, there is good data that children are, in fact, going into puberty now about one year earlier than was the case 20 years ago," Eichenfield explained.
"So it could be about hormones, about nutrition, about the obesity epidemic," he suggested. "But I would call these ideas, not even theories. We really just don't know what the reason is. But what we do know is that it's not happening just in the U.S. This is a worldwide phenomenon," he added.
"Which is why I'm very pleased that now, for the first time, we have evidence-based guidelines for the treatment of pediatric care," Eichenfield said. "And that means that parents should feel comfortable that their pediatricians and dermatologists will now have consistent and reliable ways to treat children, and minimize the negative physical and psychological impact that acne can come to have over a patient's lifetime."
For her part, Dr. Sheila Friedlander, a pediatric dermatologist
and clinical professor of pediatrics and medicine at UCSD,
expressed hope that the new recommendations will help caregivers
guide parents away from the "perfect storm of anxiety" that can
arise when confronted with preadolescent acne.
"As long as no other signs of a problem exist, such as significant armpit/groin hair or breast development, we consider this 'early acne' a normal event," she said.
"Therefore, health care givers must be prepared to provide parents with an appropriate approach to acne," Friedlander added, agreeing that most cases are eminently treatable when handled properly.
Visit the U.S. National Institute of Arthritis and
Musculoskeletal and Skin Diseases for
fast facts about acne.
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