Infantile acne

True infantile acne generally affects the cheeks, and sometimes the forehead and chin, of children aged six months to three years. It is more common in boys and is usually mild to moderate in severity. In most children it settles down within a few months.

The acne may include comedones (whiteheads and blackheads), inflamed papules and pustules, nodules and cysts. It may result in scarring.

Infantile acne

What is the cause of infantile acne?

The cause of infantile acne is unknown. It is thought to be genetic in origin. It is not usually due to excessive testosterone or other androgenic hormones and children with infantile acne are usually otherwise quite normal in appearance.

Acne is rare in older prepubertal children aged 2 to 6, when there is more likely be higher levels of androgens than is expected for the age of the child. These may result in virilisation, i.e.:

• Excessive body hair
• Abnormal growth
• Genital and breast development
• Body odour

Hormone abnormalities in children with acne may be associated with the following conditions:

• Congenital adrenal hyperplasia
• Cushing's Disease
• 21-Hydroxylase deficiency
• Precocious puberty
• Androgen-secreting tumours
• Medications
• Premature adrenarche (early puberty).

Should any tests be done?

In most babies with acne, no investigations are necessary. In older children, or if there are other signs of virilisation, the following screening tests may be useful.

• Blood tests: DHEAS, testosterone, 17-hydroxyprogesterone, LH, FSH, prolactin
• X-ray: bone age measurement

What is the result of infantile acne?

Severe infantile acne may result in permanent scarring. Individuals with severe infantile acne tend to develop troublesome acne at puberty.

Scarring from infantile acne

Treatment

Treatment of infantile acne is usually with topical agents such as benzoyl peroxide or erythromycin gel.

In severe cases, oral antibiotics such as erythromycin and trimethoprim, or isotretinoin may be required.

NOTE: tetracycline antibiotics should not used in young children because they may cause yellow staining of the developing permanent teeth.