Background
Acne vulgaris (acne) is most commonly seen in adolescents, however it can occur at any age. Paediatric acne can be further divided depending on the age of onset into: neonatal acne, infantile acne, mid-childhood acne and preadolescent acne.
Infantile acne affects children aged 6 weeks to 12 months, and is more likely to be seen in boys than girls. The aetiology of infantile acne is unknown; current theories suggest that there is a genetic component, however it may rarely indicate an underlying endocrine disorder such as:
- Congenital adrenal hyperplasia
- Androgen-secreting tumours
- 21-hydroxylase deficiency
- Premature adrenarche
Most cases of infantile acne are mild to moderately severe, are not related to a hormonal disorder and resolve in several months. Infantile acne can lead to scarring and affected children are more likely to develop severe acne later in life, therefore early treatment may be helpful.
Signs & symptoms
The following may be seen on the face and occasionally on the chest and back:
- Open & closed comedones
- Papules
- Pustules
- Nodules
- Cysts
- Scarring
If the infantile acne is related to an endocrine disorder, there may be further signs of virilisation present such as androgenic hair, or early breast and genital development.
Diagnosis
Diagnosis first requires a history and clinical examination; if examination reveals signs of an underlying condition then further investigations may be pertinent:
- Bloods for hormonal markers (DHEA, FSH, LH, testosterone, etc)
- Radiographs to determine bone age
Differentials
- Infections (e.g. Malasezzia, Molluscum contagiosum)
- External agents (oils in skin products, etc)
- Keratosis pilaris
- Periorificial dermatitis
Management
Infantile acne may present mildly and self-resolve without treatment. More severe cases may require medication to prevent scarring. Management can include:
- Topical agents (e.g. benzoyl peroxide)
- Oral medication (e.g. antibiotics or rarely isotretinoin. Note – tetracyclines are not recommended for use in children under 8 years of age as they can cause staining of the permanent teeth)
References
https://dermnetnz.org/topics/infantile-acne/