Childhood Acne

Acne during childhood (i.e., between 1 and 7 years) is rare and is primarily seen in two scenarios:
1. Persistent infantile acne
2. Hyperandrogenism

Adrenal androgens are normally quiescent throughout childhood, rising at around 7 to 8 years of age during adrenarche.
The appearance of acne prior to this age should raise concerns for hyperandrogenism that can be secondary to premature adrenarche, congenital adrenal hyperplasia (CAH), central precocious puberty, gonadal or adrenal tumors, or Cushing syndrome.

Presents similarly to infantile and adolescent acne with open and closed comedones, inflammatory papules, and pustules usually located on the face (Fig. 3.4).
Cysts and nodules may also appear.

Differential Diagnosis

Periorificial Dermatitis (see below)

Keratosis Pilaris of Cheeks

Milia

Discrete, white, superficial keratin cysts typically located around the eyes and upper cheeks.

Management

Initial assessment should include a thorough history and physical examination, including height, weight, and tanner staging. Particular attention should be given to other signs of androgen excess (see Chapter 20: Hirsutism) including body odor, axillary hair, pubic hair, etc.
If an abnormality is detected, prompt referral to a pediatric endocrinologist is indicated.
Treatment for acne lesions, is similar to treatment of acne vulgaris and includes topical retinoids (i.e., tretinoin 0.05% cream) and topical antibiotics (benzoyl peroxide and clindamycin or erythromycin). Systemic agents are reserved for more severe and recalcitrant cases (see Chapter 12: Acne and Related Disorders for formulary and treatment of acne).

Point to Remember

Acne with onset during childhood is rare and should prompt a workup for hyperandrogenemia.