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Pediatric Acne

Drug Profile
Nystatin cream
Drug Profile
Benzoyl peroxide cream
Drug Profile
Azithromycin
Drug Profile
Metronidazole Topical Cream, 0.75%
Drug Profile
Doxycycline
James Treat, MD Professor of Clinical Pediatrics and Dermatology  Perelman School of Medicine at the University of Pennsylvania

Dr. Treat is an Assistant Professor of Pediatrics and Dermatology at the Perelman School of Medicine at the University of Pennsylvania with his main clinical appointment at the Children‘s Hospital of Philadelphia. He is the education and fellowship director of Pediatric Dermatology. Dr. Treat is widely published, edited a textbook on pedatric dermatology and has given over 75 invited lectures nationally and internationally. He directs the dermatology course for the Pereleman school of medicine and has won 11 teaching awards as well as the 2013 Master Clinician Award to the Children’s Hospital of Philadelphia.

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Ask the Expert

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1. Which of the following is INCORRECT regarding neonatal acne? (Neonatal: Birth to ≤6 weeks)

Select only 1 answer.

  1. A. Benign, self-limited, asymptomatic erythematous monomorphous papules and pustules
  2. B. Referred to as “neonatal cephalic pustulosis” although can extend onto the scalp and shoulders
  3. C. The presence of comedones is common and may require a retinoid
  4. D. Thought to be associated with Malassezia yeasts and no workup is necessary

2. Which of the following is INCORRECT regarding infantile acne? (Infantile: 6 weeks to ≤1 year)

Select only 1 answer.

  1. A. Can start as early as 6 weeks but usually at 3-6 months
  2. B. Usually lasts 6-12 months and clinically this looks like adolescent acne
  3. C. Comedones, inflammatory papules and nodules
  4. D. No scarring potential and not associated with acne later in life.

3. Which of the following is INCORRECT regarding infantile acne? (Infantile: 6 weeks to ≤1 year)

Select only 1 answer.

  1. A. Infantile acne is commonly associated with endocrinopathy
  2. B. It is important to look for excess growth, advancement of Tanner Stage and clitoromegaly or enlarged testicles on exam
  3. C. If an endocrinopathy is suspected, labs to be included are: FSH, LH, DHEAS, Free and Total Testosterone, 17-OH progesterone, androstenedione
  4. D. Additional studies if an endocrinopathy is suspected should include a Bone Age

4. Which of the following is INCORRECT regarding mid-childhood acne? (Mid-childhood: 1 year to <7 years)

Select only 1 answer.

  1. A. Often a strong family history of severe acne
  2. B. Clinically this looks like adolescent acne and can have papules and nodules that can be quite severe
  3. C. There is potential for scarring potential and this form of acne is a harbinger for later acne
  4. D. Acne at this age does not require a workup

5. Which of the following is INCORRECT regarding therapy in mid-childhood acne? (Mid-childhood: 1 year to <7 years)

Select only 1 answer.

  1. A. Treatment (off label): same as adolescent acne with the exception that tetracycline derivatives should be avoided due to teeth staining
  2. B. Topical retinoids and benzoyl peroxide products are often sufficient to treat acne in this age group
  3. C. Systemic choices include erythromycin or its derivatives azithromycin, which due to its long half-life should be given 2-3x/week to avoid toxic buildup
  4. D. Isotretinoin is absolutely contraindicated in this age group

6. Which of the following is INCORRECT regarding PRE-adolescent acne? (Preadolescent: ≥7 years to ≤12 years or menarche in girls)

Select only 1 answer.

  1. A. Clinically this is adolescent acne presenting with comedones, inflammatory papules and nodules
  2. B. Generally, does not require a workup for endocrinopathy
  3. C. Signs to consider an endocrinopathy workup include: started below age 7; severe or recalcitrant; signs of androgen excess (more worrisome the closer to 8 instead of 12)
  4. D. Pre-adolescents are ideal candidates for tetracycline derivatives

7. Which of the following is INCORRECT about periorificial acne?

Select only 1 answer.

  1. A. They can mimic acne
  2. B. The distribution is characteristic with small red papules around the mouth>nose>eyes
  3. C. Risk factors include the use of topical antibiotics and/or tetracycline class antibiotics used as monotherapy
  4. D. The treatment involves topical metronidazole +/- oral erythromycin

8. Which of the following is INCORRECT regarding aseptic granulomas of the face?

Select only 1 answer.

  1. A. May have 1 or 2 individual nodules in the central parts of the cheek only
  2. B. Not true acne and thought to be a version of childhood rosacea as patients lack open and closed comedones and scattered papulopustules typical of acne
  3. C. Surgical drainage (incision and drainage) is first line therapy and usually required to prevent prolonged inflammation and scarring
  4. D. Patients may have a history of “styes” (chalazion) under the eye and consultation with an ophthalmologist for ocular rosacea is recommended in these situations