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Pediatric Acne

What is acne?

Acne is the term for plugged pores, pimples, and deeper lumps that occur on the face, neck, chest, back, shoulders, and even the upper arms.

Acne is very common: nearly 17 million people in the US are affected by this condition. Acne most often begins in puberty. During puberty, the male sex hormones increase in both boys and girls, causing the sebaceous glands to become more active. This, in turn, causes the sebaceous glands to produce more sebum, or oil.

How does acne develop?

Acne is caused by clogged sebaceous glands in the pores of the skin. The sebaceous glands produce oil (sebum), which normally travels via hair follicles to the skin surface. If skin cells plug the follicles, blocking the oil, skin bacteria (called Propionibacterium acnes, or P. acnes) grow inside the follicles, causing inflammation. Acne progresses in the following manner:

  • Incomplete blockage of the hair follicle results in blackheads (a semisolid, black plug)
  • Complete blockage of the hair follicle results in whiteheads (a semisolid, white plug)
  • Infection and irritation cause whiteheads to form
  • The plugged follicle bursts, spilling oil, skin cells, and the bacteria onto the skin surface. In turn, the skin becomes irritated and pimples or lesions develop

Acne can be superficial (pimples without abscesses) or deep (when the inflamed pimples push down into the skin, causing pus-filled cysts that rupture and result in larger abscesses).

What causes acne?

Rising hormone levels during puberty may cause acne. In addition, acne is often inherited. Other causes of acne may include the following:

  • Hormone level changes during the menstrual cycle in girls and women
  • Certain drugs (such as corticosteroids, lithium, or barbiturates)
  • Oil and grease from the scalp, mineral or cooking oil, and certain cosmetics may worsen acne
  • Bacteria inside pimples
  • Squeezing the pimples or by scrubbing the skin too hard can aggravate acne

What are the symptoms of acne?

Acne can occur anywhere on the body. However, it usually appears in areas where there is a high concentration of sebaceous glands, including:

  • Face
  • Chest
  • Upper back
  • Shoulders
  • Neck

The following are the most common signs/symptoms of acne. However, each child may experience symptoms differently. Symptoms may include:

  • Blackheads
  • Whiteheads
  • Pus-filled lesions that may be painful
  • Nodules (solid, raised bumps)

The symptoms of acne may resemble other skin conditions. Always consult a physician for a diagnosis.

What is the treatment for acne?

Acne treatment is designed to minimize scarring and improve the appearance of the skin. The specific treatment will be determined based on the following factors:

  • The severity of the acne
  • The adolescent's age, overall health, and medical history
  • The adolescent's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the condition
  • The patient’s or parent’s opinion or preference

Acne treatment may include topical or systemic drug therapy. Depending on the severity of the acne, the doctor may prescribe medications that are applied to the skin (topical) or medications taken orally (systemic). In some cases, a combination of both types medications may be used.

Topical medications come in creams, gels, lotions, or solutions. Specific topical medications that are used to treat acne include the following:

  • Benzoyl peroxide (kills the bacteria)
  • Antibiotics (helps stop or slow down the growth of P. acnes and reduces inflammation)
  • Tretinoin (stops the development of new acne lesions and encourages cell turnover, unplugging pimples)
  • Adapalene (decreases acne formation)

Systemic medications, which can be used to treat moderate to severe acne, include the following:

  • Doxycycline
  • Erythromycin
  • Tetracycline

If the acne is severe, cystic, or inflammatory, doctors may prescribe Isotretinoin (Accutane®), an oral medication that can reduce the size of the sebaceous glands that produce the skin oil, increase skin cell shedding, and affect the hair follicles to reduce the development of acne lesions.

Isotretinoin can clear acne in 90 percent of patients, but the drug has major unwanted side effects, including psychiatric symptoms. It is very important to discuss this prescription medication with a physician prior to use.




The Division of Dermatology at Children's National Hospital continues to expand services as more families seek our expertise in the diagnosis and treatment of disorders of the skin, hair and nails.

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