Infantile Acne

Infantile acne is an uncommon condition that is the result of the intrinsic hormonal imbalances that can occur during infancy.
Seen more often in boys and first appears between 2 to 6 months of age.

Infantile acne results from increased androgens and sebum excretion in susceptible infants.
All babies have elevated adrenal androgens in early infancy due to a transiently enlarged adrenal gland. In infant boys, the testes also produce luteinizing hormone (LH) and testosterone and levels can rise equal to those seen in puberty.
Both sources of androgens markedly diminish by 1 year of age and remain low for most of childhood.

Infantile acne appears strikingly similar to typical acne vulgaris that is seen in adolescence with an admixture of acneiform papules, pustules, open and closed comedones, and cysts (Fig. 3.3).
Lesions are typically located on the cheeks but can also be seen on the forehead, chin, and back.
Cysts, draining sinuses, and deep nodules with potential for scarring occasionally occur.
Onset is between 3 to 6 months and subsides at around 1 to 2 years of age commiserate with the normalization of androgen levels.
Rarely persists through adolescence.

Differential Diagnosis

Miliaria Rubra

Bacterial Folliculitis

Periorificial Dermatitis

Pomade Acne

Occlusive ointments or oils applied to the skin can trigger an acneiform eruption resembling infantile acne.

Management

Patients with infantile acne should have a complete physical examination with particular attention to other signs of androgen excess, that is, clitoromegaly, hirsutism, or pubic hair. If signs of androgen excess are present, referral to a pediatric endocrinologist is warranted.
Most cases resolve by 1 to 2 years of age, even without treatment. In rare cases, the condition can persist until 4 to 5 years old and even through adolescence.
First-line treatments are similar to those used for adolescent acne and include topical tretinoin 0.025% cream or benzoyl peroxide with or without a topical antibiotic, such as Benzaclin (benzoyl peroxide 5% and clindamycin 1%).
In severe cases, especially when there is scarring potential, oral antibiotics or isotretionoin may be required.
Antibiotic choices for acne at this age include erythromycin and trimethoprim/sulfamethoxazole.

Helpful Hints

Severe cases of infantile acne may be a marker for severe disease in adolescence.
Avoid use of tetracycline, doxycycline, or minocycline below the age of 8 years.

Points to Remember

	Neonatal Cephalic Pustulosis	Infantile Acne
Onset	2-3 wks of age	3-6 mo
Clinical	Inflammatory lesions, no comedones	Comedones ++, papules, pustules, cysts
Etiology	Malassezia spp. or increased neonatal sebum secretion rates	Elevated levels of LH and testosterone Boys > girls
Duration	Weeks to months	1-2 yrs; rarely persists through adolescence
Treatment	Imidazoles (e.g., topical ketoconazole (Nizoral) 2% cream), benzoyl peroxide	Topical tretinoin, benzoyl peroxide, oral antibiotics, isotretinoin if severe