Some recommend refraining from oral contraceptives until 1 year after menarche because of concerns about growth and bone density. When considering oral isotretinoin, remember it is teratogenic and that it causes questionable changes to bone health, mood, and bowel disorders, which may cause more issues in the pediatric population.
If there is an inadequate response after combination therapy with isotretinoin, physicians can try oral antibiotics with topical retinoids plus BP. If acne persists, consideration can be given to switch to a different oral antibiotic to address possible resistant organisms.
Remember that tetracyclines should not be used in ages younger than 8 years. Erythromycin, azithromycin, and trimethoprim/sulfamethoxazole are options for children younger than 8 years or those with a tetracycline allergy, as long as there is close monitoring for adverse events with any oral antibiotics in children.
Bottom line
The diagnosis, work-up, and management of pediatric acne vary depending upon age and pubertal onset. When approaching acne therapy, the best treatment is determined by assessment of type and severity of lesions. Use of topical BP, retinoids, antibiotics, and oral antibiotics are the base of therapy, with strength and combination of agents determined by type and severity of the acne.
Reference
Eichenfield, L.F., Krakowski, A.C., Piggott, C., Del Rosso, J., Baldwin, H., Friedlander, S.F., Levy, M., Lucky, A., Mancini, A.J., Orlow, S.J., Yan, A.C., Vaux, K.K., Webster, G., Zaenglein, A.L., Thiboutot, D.M. (2013). Evidence-Based Recommendations for the Diagnosis and Treatment of Pediatric Acne. (Pediatrics 2013;131:S163 [doi:10.1542/peds.2013-0490B]).
Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. Dr. Lee is a third-year and chief resident in the family medicine residency program at Abington Memorial Hospital.