What is Infantile Acne?
Acne vulgaris is a common skin condition identified by the presence of pimples or blemishes, known medically as comedones. Although this type of acne is not harmful itself, it can leave permanent scars and even affect a person’s self-esteem. While acne is most common among teenagers, it can affect people of all ages, including infants.
Managing acne in children can be tricky and pose challenges even for seasoned doctors. This is due to various problems. Firstly, there’s an extensive list of conditions that could be mistaken for acne. Secondly, diagnosing a child with acne could only be scratching the surface of a more serious underlying condition. Lastly, even a straightforward case of acne in children requires careful treatment decision-making considering the potential side effects, and engaging not only the patient but often their caregiver as well.
Childhood acne is categorized into four groups depending on the age it begins – neonatal acne, infantile acne, mid-childhood acne, and preadolescent acne. Infantile acne can occur anytime between 6 weeks and 12 months of age and is more common in males. Along with whiteheads and blackheads, symptoms include red bumps, pus-filled pimples, nodules, and cysts. These often appear on the face but can also be found on the chest and back. Generally, most kids with infantile acne have a moderate case which doesn’t require treatment and clears up within 6 to 12 months of appearing. However, in some instances, the acne can be severe enough to cause scarring and require medication. Children with infantile acne are at a higher risk of suffering from severe acne during their teenage years.
What Causes Infantile Acne?
The exact cause of baby acne is still unknown. Current theories propose two possibilities. Firstly, genetic factors which make some babies more likely to develop acne. Secondly, there may be a heightened response in the baby’s oil-producing glands to standard levels of hormones present in the body, known as androgens. In baby girls, androgens come from adrenal glands, while in baby boys, they are produced by both adrenal and testicular glands.
In rare cases, baby acne can signal the presence of a adrenal gland tumor. There are also isolated cases where a certain type of fungus, known as Malassezia, has been identified as a cause of baby acne.
Risk Factors and Frequency for Infantile Acne
Infantile acne is not very common, impacting less than 2% of children. In fact, recent data looking at pediatric outpatient visits in the United States from 2000 to 2010 shows that only around 9.2 million outpatient visits each year were due to pediatric acne. Neonatal and infantile acne made up only 3% of these cases. Infantile acne can occur in both boys and girls, but it is slightly more common in boys.
- Infantile acne affects under 2% of children.
- About 9.2 million outpatient visits per year in the U.S. from 2000 to 2010 were for pediatric acne.
- Of these cases, only 3% were due to neonatal and infantile acne.
- Infantile acne is more likely in boys than girls.
Signs and Symptoms of Infantile Acne
Infantile acne is a skin condition that typically affects young children between 6 weeks and 12 months old. It is diagnosed by the presence of acne-like bumps, primarily on the face but sometimes also on the chest and back.
- The main sign is comedones (skin-colored bumps) on the facial region, mainly on the cheeks.
- The severity is determined by the presence of other skin problems like pustules (pimples), nodules (larger lumps under the skin), or cysts (large, painful bumps under the skin) and how widely these are spread.
- It’s also important to examine the child thoroughly for signs of any underlying hormonal imbalance. This can include looking at their past and current growth trends.
- Other signs of potential hormonal issues can include changes like breast development, enlargement of the testicles or clitoris, the presence of pubic hair earlier than expected, or other signs of excessive hair growth.
Testing for Infantile Acne
If your baby develops severe acne quite quickly, or shows signs of unusually high amounts of the hormones androgens or corticosteroids, such as excessive hair growth (hirsutism), early development of pubic hair, or an increase in size of the testicles or clitoris (clitoromegaly), there may be an underlying medical condition causing this. In this case, further tests may be needed, and you may need to see a pediatric endocrinologist, a doctor who specializes in children’s hormonal issues.
These tests could include checking your child’s bone age, this is to see if their bones are developing faster than normal. The doctor may also want to test their blood for several hormone levels such as dehydroepiandrosterone sulfate (DHEAS), luteinizing hormone (LH), follicle-stimulating hormone (FSH), and free testosterone. Each of these tests will help the doctor determine if there’s an underlying hormonal issue causing the acne.
Treatment Options for Infantile Acne
Most babies that have infantile acne, a condition where acne appears in the first 6 months of life, experience moderate symptoms that don’t require treatment. This acne usually goes away on its own within 6 to 12 months. However, some cases can be quite severe and may need to be treated with medication. It’s important to note that there are currently no medications specifically approved by the USFDA for treating acne in children under the age of nine, therefore, the treatment used is typically the same as that given to older children or adults.
If the infantile acne is not severe, a topical retinoid or benzoyl peroxide could be applied on the skin. These treatments can be used alone or together. If the acne has a lot of inflammation, a topical antibiotic might be added to the treatment regimen. However, topical antibiotics should never be used alone due to the risk of creating antibiotic-resistant strains of the bacteria associated with acne (Propionibacterium acnes). To counter this risk, benzoyl peroxide, which has antimicrobial properties, can be used alongside the antibiotic.
For severe acne, especially if there is scarring or the possibility of scarring, oral antibiotics might become necessary. Erythromycin would typically be the first choice, unless the patient has an antibiotic-resistant strain of Propionibacterium acnes, in which case a different antibiotic, such as sulfamethoxazole-trimethoprim, could be used. Certain antibiotics, like tetracycline-based ones, should not be used in children under eight years old because they can cause discoloration of permanent teeth.
Other treatment options for severe cases of acne include injections for individual pimples and cysts or oral isotretinoin for cases that are particularly severe and are not responding to other forms of treatment. Isotretinoin is a very effective medication but it needs to be carefully supervised as it can cause side effects. Regular checks, both through physical examination and lab tests, are necessary when taking this medication. It would also be helpful to consult a dermatologist before initial administration.
What else can Infantile Acne be?
When checking a baby for skin spots that look like acne, the doctor considers several other conditions that might share similar symptoms. These conditions include:
- Periorificial dermatitis (a skin condition causing spots around the mouth and nose)
- Keratosis pilaris (bumps on the skin, often in the arms and thighs)
- Effects from foreign substances, such as steroid acne, acne pomade, or chloracne (a type of acne caused by certain chemicals)
- Infections like molluscum contagiosum (a common skin infection causing small, firm bumps)
What to expect with Infantile Acne
Most of the time, babies diagnosed with infantile acne will not experience severe symptoms, and the acne usually clears on its own by the time they are 1 to 2 years old. However, in some cases, the acne may be more severe and require medication.
With the proper care from a healthcare professional, who ensures that the correct diagnosis is made and the right level of treatment is given, even the more serious cases of acne can turn out well. This includes educating parents or caregivers about the condition and its treatment. So, the overall outlook for infantile acne is still considered very good.
Possible Complications When Diagnosed with Infantile Acne
Infantile acne can lead to several skin changes, some of which are temporary and some that are permanent. Minor effects such as residual redness and dark spots (known as postinflammatory hyperpigmentation) in babies with darker skin are generally not long-lasting. With the right treatment and some time, these conditions usually improve. However, it’s important to know that even after the acne itself has cleared up, these skin changes can linger for several months.
Frequent Outcomes:
- Residual redness
- Dark spots on skin (postinflammatory hyperpigmentation)
However, infantile acne can sometimes be severe. If the acne is particularly vigorous, there’s a chance it could result in permanent scarring, which might lead to social and emotional difficulties. Early diagnosis and prompt treatment can help reduce these risks, but even so, some babies might still experience stubborn acne that lasts a long time even with optimal treatment. In some cases, they might continue having acne outbreaks not just in infancy, but even extending into puberty and potentially transforming into a severe form of adolescent acne.
Severe Cases:
- Potential for permanent scarring
- Social and emotional issues
- Persistent acne lasting into puberty and potentially progressing to severe adolescent acne
Preventing Infantile Acne
Infantile acne is a condition that requires active participation and detailed knowledge from the parent or caregiver. The doctor should explain the assessment and lessen any possible side-effects linked to the chosen treatment method. It’s also crucial for the doctor to spend time talking about why it’s important for the caregiver to understand and manage their expectations during the treatment process.
