Acne Vulgaris in the Pediatric Patient

Rosalind Ashton; Miriam Weinstein

doi:10.1542/pir.2018-0137

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Rosalind Ashton, MD, MSc*
Miriam Weinstein, MD, FRCPC^†

^*King's College London School of Medical Education, St. John's Institute of Dermatology, London, United Kingdom
^†The Hospital for Sick Children, Toronto, Ontario, Canada

AUTHOR DISCLOSURE
Dr Ashton has disclosed no financial relationships relevant to this article. Dr Weinstein has disclosed funding from La Roche Posay through her hospital's charitable foundation for a program to teach patients with eczema and their families about the disease and how to manage it; is an advisory board leader/lecturer on eczema for Pfizer; is an advisory board member for Amgen and Pfizer on eczema; is an advisory board consultant for Sanofi Genzyme; is a consultant for Unilever; and is a consultant for Paladin Labs. This commentary does contain a discussion of an unapproved/investigative use of a commercial product/device.

Abbreviations:

BPO:: benzoyl peroxide
D+A/BPO:: doxycycline + adapalene/benzoyl peroxide
DRESS:: drug reaction with eosinophilia and systemic symptoms
FDA:: Food and Drug Administration
IBD:: inflammatory bowel disease
PDL:: pulsed dye laser
TLR:: Toll-like receptor

Practice Gap

Acne vulgaris is a common disease seen in pediatric practices, and pediatricians should be able to develop management strategies using standard therapies, including retinoids.

Objectives

After completing this article, readers should be able to:

Describe the pathophysiology of acne.
Outline treatment options based on a patient’s clinical presentation.
Discuss mechanisms of action and adverse effects of common acne medications.
Explain treatment options for postacne sequelae.

Introduction

Acne vulgaris is a ubiquitous disease of the pilosebaceous unit, characterized by a long-term course with recurrences and relapses. It affects approximately 85% of adolescents and may persist until well into a patient’s 20s and 30s. (1)(2)(3) Psychological sequelae can be substantial and should not be underestimated. This common, very visible skin condition presents at a time when appearance is acutely important and noticeable disease marring that appearance is distressing. Embarrassment contributes to lower self-esteem and feelings of unattractiveness and worthlessness, which may be present not only during active flare-ups but also with long-lasting postinflammatory hyperpigmentation and permanent scarring. (4)

The aim of this review is to offer up-to-date information on pathophysiology, evaluation, and management strategies for this common disease.

The treatment of acne conglobata, acne fulminans, cloracne, drug-induced acne, hidradenitis …