Acne vulgaris in preadolescent children: recommendations for evaluation

Pediatric Acne Vulgaris: A Guide for Recognition, Examination, Referral, and Treatment

Acne is a common skin condition in adolescent patients but much less common in childhood. Pediatric providers should be familiar with the varying presentations in the pediatric population and recognize when additional physical signs of hyperandrogenism are present. This article details the pathogenesis and presentation of acne in infancy, mid-childhood, and preadolescence. The differential diagnosis is discussed and recommendations for initial workup, referral, and treatment are provided. [Pediatr Ann. 2024;53(4):e115-e120.].

Acne incidence in preadolescents and association with increased body mass index: A population-based retrospective cohort study of 643 cases with age- and sex-matched community controls

BACKGROUND/OBJECTIVES

Little is known about acne incidence in preadolescents and its potential association with body mass index (BMI). Our study aims to determine acne incidence in preadolescents and its association with BMI.

METHODS

A population-based retrospective cohort study identified 7- to ≤12 year-olds with an initial acne diagnosis during 2010-2018, and incidence was calculated. Two age- and sex-matched controls without acne were randomly selected per case, and BMI was recorded.

RESULTS

A total of 643 acne patients were identified. Annual age- and sex-adjusted incidence rate was 58.0 per 10,000 person-years, higher in females vs. males (89.2 vs. 28.2 per 10,000 person-years, p < .001), and increased with age (4.3, 24.4, and 144.3 per 10,000 person-years among 7-8, 9-10, and 11-12 year-olds, respectively, p < .001). Systemic medication use was associated with increasing BMI (odds ratio = 1.43 per 5 kg/m2 increase in BMI, 95% CI 1.07-1.92, p = .015). Median BMI percentile was higher among acne cases vs. controls (75.0 vs. 65.0, p < .001), as was the proportion with BMI ≥95th percentile (16.7% vs. 12.2%, p = .01).

CONCLUSION

Acne incidence is higher in preadolescent girls than boys and increases with age. Preadolescents with acne are more likely to be obese than those without acne. Those with higher BMIs are more likely to be given systemic treatment.

A Comparative Clinical and Laboratory Study of Adolescent and Adult Acne in Iraqi Women

Background Acne vulgaris is a common chronic inflammatory disease of the pilosebaceous units associated with long-term sequelae and complications. Currently, acne in women is classified into adolescent and post-adolescent forms. However, comparative studies evaluating the clinical and laboratory parameters across various age groups in women with acne are lacking. The aim of the study is to compare the clinical and laboratory characteristics of different groups of women with acne vulgaris. Patients and methods Over 3 years (2018-2021), a cross-sectional study was carried out on 340 women with acne consulting the Dermatology and Venereology Outpatient Clinic, Basrah Teaching Hospital, Basrah, Iraq. Eligible patients were carefully evaluated and fully examined, emphasizing on signs of hyperandrogenism and scoring of acne severity. Hormonal assays of serum total testosterone (TST), dehydroepiandrosterone sulfate (DHEAS), luteinizing hormone (LH), follicular stimulating hormone (FSH), and serum prolactin (PRL) were done. Pelvic ultrasonography was performed to identify any pelvic pathology. The patients were classified according to their age of onset. Clinical and laboratory data were compared among groups. Results Three groups were recognized: 160 patients (47%) with adolescent acne (AA) (mean age SD: 17.2±1.6 years), 80 (23.5%) with early adult-onset acne (EA) (mean age SD: 21.4±1.2 years), and 100 (29.4%) with post-adolescent acne (PA) (mean age SD: 28.7±2.9 years), which were further sub-grouped into late-onset acne (40 cases, 11.7%), and persistent acne (60 cases, 17.6%). The mean body mass index was normal in the AA group and overweight in the EA and PA groups. Moderate obesity was more frequent in PA (24%, p=0.03). While 78.5% of AA was mild to moderate acne, 77.5% of EA was moderate to moderately severe, and 72% of PA was moderately severe to severe. Clinical and biochemical markers of hyperandrogenism were seen in all groups, however, they were more frequent in PA and EA groups than in the AA group (p<005). Conclusion Clinical and biochemical hyperandrogenism were present in a significant proportion of women with acne; their prevalence was higher in post-adolescent acne than in adolescent acne. Acne that began between the ages of 20 and 25 was classified as "early adult-onset acne," and showed variable features of hyperandrogenism. A complete evaluation, regardless of age, for every female with acne, including a hormonal analysis and pelvic ultrasound examination to detect hormonal imbalances as early therapy, can help to prevent and reduce the risk of consequences.

The use of isotretinoin in acne therapy in early childhood and its effect on the occurrence of acne symptoms later in life. Eight-year follow-up

Introduction

Acne vulgaris is a chronic inflammatory skin disease of the pilosebaceous follicles that affects patients of all ages.

Aim

Use of isotretinoin in the early stages of the disease to prevent subsequent lesions of acne, including prolonged treatment and acne scars at a later age.

Material and methods

A retrospective, comparative study was carried between January 2010 and November 2018. The study population consisted of 90 children aged 9-18 years with acne. During treatment by isotretinoin the clinical evaluation was done every month. Patients were divided into three groups according to age. One of the qualification criteria was follow-up visits.

Results

A total of 90 children (67.8% females; mean age: 13.5 years) were enrolled. In group A (30 individuals - aged 9-11) and B (30 individuals - aged 12-13), treatment was terminated 2 months after clinical improvement (mean: 3 months). In control group C (30 individuals - aged 14-18), treatment was carried out using average cumulative dose 135 mg/kg bw/day. All groups showed up for follow-up. after 1 to 8 years. In groups A and B, 13 people underwent a second acne treatment; in 3.33% oral isotretinoin was used, in 18.33% topical treatment. In group C, 30 (100%) individuals underwent a second acne treatment; in 20% oral isotretinoin was used, and 80% required a topical treatment. Acne scars and post acne hyperpigmentation have been documented in 73.33% in group C.

Conclusions

Early, reasonable and short-term use of isotretinoin can reduce the incidence of acne in the future and reduce the occurrence of secondary acne symptoms.

[Acne]

Acne vulgaris is one of the most frequent dermatological diseases with a lifetime prevalence of about 85%. The clinical spectrum shows a great variety. Key factors of pathogenesis are increased sebum production, hyperkeratinization of the follicular infundibulum, inflammatory processes, and a dysbiosis of the skin microbiome. In addition to endogenous factors (e.g., disturbances of the androgen metabolism) or other hormonal changes, exogenous factors (e.g., diet, mechanical irritation or the use of inappropriate cosmetics) can also play an important role. The clinical spectrum is broad, extending from neonatal Acne (A.) to adult A., from comedonal A. to fulminant A., from cosmetic A. to A. excoriée (skin picking disorder). The psychological effects of acne can be profound and can cause a severe reduction in quality of life. Therefore, in addition to an effective therapy with regular medical check-ups and good adherence, it is always necessary to consider psychological aspects.

Prediction of neonatal acne based on maternal lipidomic profiling

BACKGROUND

Neonatal acne occurs in the first few weeks after birth. Some lesions are more serious and leave scars. Maternal surface skin lipids (SSL) have a strong correlation with SSL of infants. The establishment of prediction rank model based on maternal SSL is essential to the prevention and treatment of neonatal acne.

METHOD

Surface skin lipids samples were collected from the mothers (M) of 56 neonatal acne patients and the mothers (HM) of 19 healthy infants. Surface skin lipids from the right forehead were collected using a noninvasive method. UPLC-QTOF-MS was applied to detect SSL. Partial least squares discriminant analysis and receiver operating characteristic (ROC) analysis were performed to screen and validate potential lipids. Random forest (RF) and ROC analysis were used to establish a prediction model and evaluate its accuracy.

RESULTS

Sixteen altered potential lipids belonging to fatty acids, sphingomyelins, and glycerides were associated with M. M had less lipids than HM. Spearman's correlation of 16 lipids revealed 9 with high correlation. They were chosen as characteristic values of the RF prediction model. And the model showed an average accuracy of 98% in the validation set.

CONCLUSION

We have established an RF model for predicting neonatal acne and have shown that high skin barrier-related lipids were markers for predicting neonatal acne.

Hand MRI and the Greulich-Pyle atlas in skeletal age estimation in adolescents

OBJECTIVE

To evaluate the feasibility of hand MRI in age assessment in adolescents using the Greulich-Pyle (GP) atlas criteria.

MATERIALS AND METHODS

Two radiologists, who were blinded to the study subjects' chronologic ages, semi-objectively evaluated 1.5-T MRIs of the left hands of ten patients (13.5 ± 2.6 years) who had left-hand radiographs and 50 healthy volunteers (15 ± 2 years).

RESULTS

A coronal T1-weighted, volumetric, interpolated, breath-hold examination with water excitation (T1 VIBE-3D-WE) achieved the best image quality. The correlation between estimated patients' ages on radiographs and MRI was high. The average estimated age difference between the MRIs and radiographs was -0.05 years for reader 1 and -0.175 years for reader 2. The interclass coefficients (ICCs) showed high interobserver agreement (radiographs: ICC = 0.95, MRI: ICC = 0.97). The ICC, calculated separately for the male and female volunteers' estimated ages by MRI, also showed a high agreement between the two readers (male: ICC = 0.97, female: ICC = 0.95). Reader 1 estimated 94% of volunteers within 2 standard deviations (SD) and 62% within 1 SD. The results for reader 2 were 92% and 54%, respectively. Thirty-nine percent of girls and 27% of boys were estimated to be older using 1 SD.

CONCLUSION

MRI of the left hand is a feasible alternative to hand radiographs for skeletal age estimation in adolescents using the GP criteria with 2 SD. Using 1 SD, the age of healthy volunteers tended to be estimated as higher than the chronologic age. Future studies should evaluate the results in a larger number of participants.

Evaluation and Management of Refractory Acne Vulgaris in Adolescent and Adult Men

Acne vulgaris alters the normal skin physiology, impairing stratum corneum and transepidermal water loss. A male's normal skin physiologic state is different than a female's and may have implications when choosing treatment when the skin is altered in a disease state. Transepidermal water loss, pH, and sebum production are different between the sexes. Several underlying conditions present in male acne patients at several ages that may require a more in-depth evaluation. As knowledge of the pathogenesis of acne expands, the differences in skin physiology between the sexes may alter the manner in which male patients with acne medications are approached.

Fragility of epidermis in newborns, children and adolescents

Within their first days of life, newborns' skin undergoes various adaptation processes needed to accommodate the transition from the wet uterine environment to the dry atmosphere. The skin of newborns and infants is considered as a physiological fragile skin, a skin with lower resistance to aggressions. Fragile skin is divided into four categories up to its origin: physiological fragile skin (age, location), pathological fragile skin (acute and chronic), circumstantial fragile skin (due to environmental extrinsic factors or intrinsic factors such as stress) and iatrogenic fragile skin. Extensive research of the past 10 years have proven evidence that at birth albeit showing a nearly perfect appearance, newborn skin is structurally and functionally immature compared to adult skin undergoing a physiological maturation process after birth at least throughout the first year of life. This article is an overview of all known data about fragility of epidermis in 'fragile populations': newborns, children and adolescents. It includes the recent pathological, pathophysiological and clinical data about fragility of epidermis in various dermatological diseases, such as atopic dermatitis, acne, rosacea, contact dermatitis, irritative dermatitis and focus on UV protection.

Acne: Kids are not just little people

Acne vulgaris is a common inflammatory disease of the pilosebaceous follicles that affects patients of all ages, from neonates to adults. We have compared and contrasted the clinical presentation of acne in neonates, infants, children, teenagers, and young adults and review the scenarios in which further systemic endocrine or hormonal tests are indicated. We also discuss age-dependent treatment considerations, including appropriate oral antimicrobial regimens and the proper dosing of isotretinoin in young children versus teenagers and adults.