Common Skin Conditions in Children and Adolescents: Acne

Area of Science:

• Dermatology
• Inflammology
• Microbiology

Background:

• Acne vulgaris is a prevalent, chronic inflammatory disorder of the pilosebaceous unit, impacting 85% of adolescents.
• It presents significant psychosocial and financial burdens, necessitating effective management strategies.
• Pathogenesis involves follicular alterations, Cutibacterium acnes colonization, androgen-influenced sebum production, and inflammation.

Purpose of the Study:

• To provide an evidence-based overview of acne pathogenesis, risk factors, diagnosis, and management.
• To outline first-line and adjunctive therapies for mild, moderate, and severe acne.
• To highlight special considerations for specific patient populations.

Main Methods:

• Literature review of evidence-based risk factors, diagnostic criteria, and treatment guidelines for acne.
• Analysis of pharmacological interventions, including topical and oral agents.
• Consideration of special populations and risk management programs.

Main Results:

• Mild acne management includes benzoyl peroxide, topical retinoids, and/or topical antibiotics.
• Moderate to severe acne (in patients >8 years) is treated with oral tetracyclines or oral isotretinoin.
• Oral/topical antibiotic monotherapy is discouraged due to resistance; combined oral contraceptives and spironolactone are options for females.

Conclusions:

• Acne treatment requires clinical diagnosis based on age, morphology, and severity, with clear expectation setting.
• Special populations like those with skin of color, pregnant, or transgender/gender diverse individuals need tailored approaches.
• Careful consideration of teratogenic effects (e.g., isotretinoin via iPLEDGE REMS) and antimicrobial resistance is crucial.