How to Safely Treat Pre-Teen Acne: Your Safe and Not-So-Safe Options
What do you do when your
pre-teen child is unhappy and defiant, feeling depressed or alienated because
she or he has PIMPLES? And they are only 9 or 10 years old! The situation
obviously cannot be ignored, so how do you treat children with PRE-TEEN acne
Most people associate acne
with the teenage years and accept acne as a normal part of growing up. More
recently, pre-teen or pre-adolescent acne is gaining more attention from
pediatricians, dermatologists and of course pre-teens along with their parents.
In fact, in May 2013 the American Acne and
Rosacea Society (AARS) published guidelines for the
"Diagnosis and Treatment of Pediatric Acne" which was subsequently
endorsed by the American Academy of Pediatrics. In part, this increased
attention to pre-teen acne (ages 8-12) results from observations that this
younger age group is now experiencing acne.
A study published by Lucky
et al revealed acne lesions in 78% of 365 girls ages 9 to 10.
The fact that acne is
occurring at this young age is an issue of special concern since the majority
of clinical trials for acne medications are conducted in patients 12 years of
age or older. As a result, there is little published evidence regarding the
safety and efficacy of many acne medications in patients younger than 12 years
The causes (pathogenesis)
of acne vulgaris (common acne) appears to be similar at all ages, so we assume
that the same factors responsible for teenage acne are involved in pre-teen
- Increased sebaceous
gland secretions influenced by increasing androgen levels
Clogging of the pores
of the skin with excess sebum and dead skin cells (white heads and black heads)
Growth of bacteria (Propionibacterium
acnes) in the clogged pores
Start of the
inflammatory cascade in people with more serious acne.
As the causes of acne may
be similar, should we also assume that the treatment may be?
Unfortunately NOT, because younger children are obviously in a different
development stage than older teens, and the medications used for older
adolescents and adults have not been tested on pre-teens. As a result, a
healthy dose of skepticism and special attention has to be given to this
Pre-Teen Acne Treatments -
Safe, Safer and Not-So-Safe Options
So far, the list of
available over-the-counter (OTC) options, products and prescriptive drugs for
pre-teen acne does not differ from those that have been developed for teen and
adult acne. And this creates a potential problem and requires active
participation from parents.
There are no products
specifically developed or approved for pre-teen acne, therefore, since we are
dealing with the really young, in their formative stages for both body and
mind, special care has to be taken when considering which products to use. As a
result, the standard treatment progression utilized for teen acne needs to be
modified if applied to pre-teens:
- Benzoyl peroxide (BP),
commonly used in topical products for mild acne. For younger children
it is important to monitor for signs of skin irritation and a drying
effect. If you opt to use it, start with the lowest concentration of
BP. Just a side note - BP does not address the causes of acne but it
can control the growth of bacteria that cause the inflammation.
- Topical retinoids
are considered for all types and severities of acne in adolescents and
adults either as mono therapy or in combination products and regimens. Topical
retinoids can be associated with severe side effects such as skin
irritation, peeling, and most notably sun sensitivity. Again - for young
teens, these effects may be much more damaging. Therefore, the
lowest concentration of retinoids should be used if this treatment is
employed. Also keep in mind, retinoids
address symptoms, not causes of acne.
- Topical antibiotics
take a long time to work, and due to the possibility of developing of
antibiotic resistance and other adverse side effects, they are not recommended as mono therapy
for young teens for more than a few weeks. If used at all, they are
usually combined with benzoyl peroxide. Topical antibiotics address the presence of
bacteria, not over production of sebum.
- Oral antibiotics
for moderate-to-severe inflammatory acne vulgaris are often
prescribed by physicians. However, according to the American Academy of
Pediatrics, tetracycline derivatives (tetracycline, doxycycline, and
not be used in younger children. Oral antibiotics
can damage tooth enamel and developing bones in pre-teens.
(known under the brand of Accutane or its generics) has been recommended
for severe acne and chronic acne in older adolescents and adults.
There is a clear consensus that NONE of the Isotretinoin
containing products should be used for pre-teens due to the severe side
effects associated with these products.
It is clear that when
evaluating the options for pre-teen acne, the preferred course of treatment
should have the highest level of safety record and the lowest possible dose for
this age group.
rationale of most of the current treatments is similar for all ages and focuses
on the treatment of existing pimples rather than the prevention of acne. This
particular point was cited in the most recent guidelines from AARS which
emphasize that the prevention of "microcomedones" (precursor to
pimples on the surface of the skin) is a critical pre-teen acne focus.
is the not-clinically-apparent precursor of both comedonal and inflammatory
lesions. It is a product of hyperactive sebaceous glands and altered follicular
growth and differentiation.
in existing microcomedones and prevention of the formation of new ones is
central to the management of all acne lesions."
Safe Treatments that
Prevent Pre-Teen Acne
The take home message from
this rather complicated discussion is to look for safe products that will
ultimately prevent pimples from forming. To date, the only product that is
administered systemically that prevents new acne from forming is Isotretinoin,
which, with all its highly publicized serious and long-term side effects, is absolutely NOT recommended
for younger teens and, if even considered, is reserved (with serious caution
and a full disclosure of possible health hazards) for the most severe cases of
AcnEase® is a proprietary botanically derived natural medicine that prevents the formation of new acne.AcnEase® works
to help the body to decrease sebaceous gland secretions, the hallmark for acne
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adverse side effects while used short or long term. Most importantly, this
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that start to develop acne, and usually provides positive results with the use
of the mild regimen.
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