Evidence-Based Recommendations for the Diagnosis and Treatment of Pediatric Acne

Author:

Eichenfield Lawrence F.1,Krakowski Andrew C.1,Piggott Caroline1,Del Rosso James2,Baldwin Hilary3,Friedlander Sheila Fallon1,Levy Moise4,Lucky Anne5,Mancini Anthony J.6,Orlow Seth J.7,Yan Albert C.8,Vaux Keith K.9,Webster Guy10,Zaenglein Andrea L.1112,Thiboutot Diane M.12

Affiliation:

1. Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego and Departments of Pediatrics and Medicine (Dermatology), University of California, San Diego, San Diego, California;

2. Section of Dermatology, Valley Hospital Medical Center, Las Vegas, Nevada;

3. Department of Dermatology, SUNY Downstate Medical Center, Brooklyn, New York;

4. Pediatric/Adolescent Dermatology, Dell Children's Medical Center, Austin, Texas, Department of Dermatology, UT Southwestern Medical School, Dallas, Texas and Departments of Pediatrics and Dermatology, Baylor College of Medicine, Houston, Texas;

5. Departments of Dermatology and Pediatrics, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;

6. Departments of Pediatrics and Dermatology, Northwestern University Feinberg School of Medicine and Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago;

7. The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York;

8. Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania and Departments of Pediatrics and Dermatology, Perelman School of Medicine at the University of Pennsylvania;

9. Division of Pediatrics and Hospital Medicine, Rady Children's Hospital, San Diego, California and Department of Pediatrics, University of California, San Diego, California;

10. Department of Dermatology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania;

11. Department of Dermatology, The Pennsylvania State University College of Medicine; and

12. Department of Pediatrics, Penn State Hershey Children's Hospital, Hershey, Pennsylvania

Abstract

INTRODUCTION: Acne vulgaris is one of the most common skin conditions in children and adolescents. The presentation, differential diagnosis, and association of acne with systemic pathology differs by age of presentation. Current acknowledged guidelines for the diagnosis and management of pediatric acne are lacking, and there are variations in management across the spectrum of primary and specialty care. The American Acne and Rosacea Society convened a panel of pediatric dermatologists, pediatricians, and dermatologists with expertise in acne to develop recommendations for the management of pediatric acne and evidence-based treatment algorithms. METHODS: Ten major topic areas in the diagnosis and treatment of pediatric acne were identified. A thorough literature search was performed and articles identified, reviewed, and assessed for evidence grading. Each topic area was assigned to 2 expert reviewers who developed and presented summaries and recommendations for critique and editing. Furthermore, the Strength of Recommendation Taxonomy, including ratings for the strength of recommendation for a body of evidence, was used throughout for the consensus recommendations for the evaluation and management of pediatric acne. Practical evidence-based treatment algorithms also were developed. RESULTS: Recommendations were put forth regarding the classification, diagnosis, evaluation, and management of pediatric acne, based on age and pubertal status. Treatment considerations include the use of over-the-counter products, topical benzoyl peroxide, topical retinoids, topical antibiotics, oral antibiotics, hormonal therapy, and isotretinoin. Simplified treatment algorithms and recommendations are presented in detail for adolescent, preadolescent, infantile, and neonatal acne. Other considerations, including psychosocial effects of acne, adherence to treatment regimens, and the role of diet and acne, also are discussed. CONCLUSIONS: These expert recommendations by the American Acne and Rosacea Society as reviewed and endorsed by the American Academy of Pediatrics constitute the first detailed, evidence-based clinical guidelines for the management of pediatric acne including issues of special concern when treating pediatric patients.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology, and Child Health

Reference171 articles.

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4. Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature.;Ebell;Am Fam Physician,2004

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