By Gary M. White, MD
Infantile acne should be distinguished from neonatal acne. Neonatal acne occurs in the first 6 weeks of life whereas infantile acne predominantly occurs in children 6 weeks to 1 year of age. Acne beyond 1 year of age has been called middle acne and should raise the possibility of hyperandrogenism.
The face, particularly the cheeks, has comedones and small inflammatory papules of acne. In advanced cases, inflammatory nodules may be present.
Topical acne medications such as benzoyl peroxide (e.g., 2.5%) and a retinoid (e.g., tretinoin or adapalene cream) should be used, each once a day. The parents should watch for undue irritation and switch to every other day application if needed, particularly for the benzoyl peroxide. If there is persistent disease or larger nodules, oral antibiotics may be given, e.g., erythromycin 125 BID or trimethoprim 100 mg BID. Because of age and concerns about the teeth, tetracyclines must not be given. Long-term administration (e.g., 12-24 months) of oral antibiotics is often required. In one study, time to clearance was 6-40 months. Oral isotretinoin [Peds Derm Sept 2013 ] is rarely needed (especially if there is imminent scarring). Contents of isotretinon capsules may be added to yogurt and immediately consumed. Alternatively, capsules may be frozen and added to a candy bar. Mild cases may resolve without treatment.
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