Pediatricians Endorse New Acne Treatment Guidelines

Experts note many medications now available for range of cases

Monday, May 6, 2013

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MONDAY, May 6 (HealthDay News) -- Pimples have long been the bane of teenage existence, but pediatricians say there is now enough evidence on effective treatments to put out the first guidelines on battling acne in children.
There is a range of medications that can clear up even severe cases of acne, according to the American Academy of Pediatrics (AAP). Writing in the May issue of its journal Pediatrics, the group throws its support behind new guidelines from the American Acne and Rosacea Society that detail how to treat acne in children and teens of all ages.
That "all ages" part is important because acne is becoming more and more common in pre-teens, too, said Dr. Lawrence Eichenfield, the lead author of the AAP report. One study of 9- and 10-year-old girls found that more than three-quarters had pimples.
It's thought that it may be because boys and girls are, on average, starting puberty earlier compared with past generations, said Eichenfield, a pediatric dermatologist at Rady Children's Hospital in San Diego.
According to the AAP, mild acne often can be tackled with over-the-counter fixes. Washes, lotions and other products containing benzoyl peroxide are the best studied, and the best place to start, the group said.
"It's a pretty effective agent, especially for mild acne," Eichenfield said. Benzoyl peroxide is also the most common ingredient in over-the-counter acne fighters. Another common one is salicylic acid, but there has not been much research on it. When it has been tested head-to-head against benzoyl peroxide, Eichenfield said, the latter has won out.
If over-the-counter products do not do the job, the next step could be topical retinoids -- prescription medications like Retin-A, Avita and Differin. They are vitamin A derivatives and work by speeding up skin cell turnover, which helps unclog pores.
The main side effects of all the topical treatments are skin irritation and dryness, the AAP said.
If the acne is moderate to severe, oral antibiotics could be added to the mix because bacteria that live on the skin play a role in acne. When pores become clogged with oil and skin cells, bacteria can grow in the pore and cause inflammation. Antibiotics help by killing bacteria and soothing inflammation.
But, Eichenfield said, "it's important to use antibiotics appropriately." One reason is because acne-causing bacteria have become less sensitive to common antibiotics in the past couple decades, due to widespread use of the drugs.
Another is that antibiotics can have side effects, such as stomach upset, dizziness and, in girls, yeast infections.
When acne is severe and other treatments have failed, the AAP said, doctors and parents might consider the prescription drug isotretinoin -- brand-names including Roaccutane (formerly known as Accutane) and Claravis.
The drug is very effective, but it can cause birth defects, so girls and women have to use birth control and get regular pregnancy tests if they go on the medication. Isotretinoin also has been linked to inflammatory bowel disease, depression and suicidal thoughts in some users -- although it's not clear the drug is to blame, the AAP said. (Severe acne itself can cause depression and suicidal thoughts, for example.)
Dr. David Pariser, a dermatologist not involved in the recommendations, said they are "based on sound evidence" and reflect the "best practices" in battling acne.
When should parents consider taking their child to a doctor for acne treatment? It depends on how severe the problem is, and how bothered the child is, said Pariser, who sits on the board of directors of the American Academy of Dermatology.
Some kids can deal with skin eruptions, but Pariser said he sees others who refuse to leave the house.
Both he and Eichenfield said it's important to dispel kids' (and sometimes parents') acne myths. "Acne is not caused by dirt or poor hygiene," Eichenfield said, and harshly scrubbing your face will probably make the situation worse.
It's best to wash your face gently twice a day, with a soap-free pH-balanced cleanser, the AAP said. Facial toners -- which commonly come in pre-packaged acne regimens -- can help clear away oil. But the group suggested going easy on toners, since they can irritate the skin.
And what about food? "The medical community has swung back and forth on that over the years," Pariser said. Years ago, people thought that certain foods, like chocolate, sugar and iodine, promoted breakouts, but studies starting in the late 1960s failed to confirm that.
"The idea that food plays a role became relegated to myth," Eichenfield said. But recently, he added, some researchers have been revisiting the issue. There is some evidence that a sugary diet may promote acne, for example. But for now, it's not clear whether any diet changes will actually help keep kids' skin clear, Eichenfield said.
The bottom line, he said, is that many treatment options are available. "There's no reason that children have to live with acne that is severe and troubling to them," he said.

SOURCES: Lawrence Eichenfield, M.D., chief, pediatric and adolescent dermatology, Rady Children's Hospital, San Diego; David Pariser, M.D., Pariser Dermatology, Norfolk, Va.; May 2013 Pediatrics

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