Acne in children is a common skin condition during preadolescent and adolescent years. Acne can appear as blackheads and whiteheads–called comedones, and pustules, nodules and cysts. They mostly occur due to sebum or oil overproduction, which is triggered by hormonal changes, and is also due to blocked pores, inflammation, and a skin baceteria called Cutibacterium acnes. Pimples may be painless and asymptomatic but some may even cause discomfort and pain. Also, the psychosocial and emotional toll of acne may be quite significant.
Read on to learn about the causes, types, treatment options, and preventive measures of acne in children.
Prepubertal Acne In Children
Acne is common during the teenage years but may also occur before and around puberty. The following are the various types of acne found in childhood before the onset of teenage years (1).
- Neonatal acne: It is found among infants up to the age of six weeks. It mostly presents as blackheads or whiteheads over the scalp, cheeks, forehead, chin, upper chest, and back. It occurs due to the crossing of androgen hormones from the mother to the baby via the placenta.
- Infantile acne: It is found in infants between the ages of six weeks and 12 months but most commonly appears from two to six months of age. The common site of infantile acne is the cheeks. It occurs when testosterone hormones cause over stimulation of the sebaceous glands (oil glands). It tends to be more common among boys.
- Mid-childhood acne: It is a rare type of acne that occurs in children between the ages of one and six years. It may occur due to excess production of androgen hormones in the body.
- Preadolescent acne: It happens in children between the ages of seven and 12 years. It is common for this age group and marks the beginning of puberty. Preadolescent acne is commonly seen on the T-zone of the face, which includes the forehead and the nose.
Except for preadolescent acne, the other forms of acne are temporary and often do not need any treatment. Acne in children refers to preadolescent acne since it is the condition that marks the beginning of hormonal changes that would continue through the teenage years.
Causes Of Acne In Children
Acne occurs when the skin pores are blocked by a mixture of sebum (oil), dead skin cells, and bacteria (2). The hormonal changes in preadolescents cause the sebaceous glands (oil glands) to produce excess sebum. The excess oil clumps with dead skin cells and clogs the skin pore, causing acne. When acne bacteria invade the trapped oil, it can cause the acne to become painful and inflamed (3).
Acne can also be exacerbated or aggravated by various factors, including (4) (5).
- Excessive production of sebum. The increased production of androgens among preadolescents causes sebaceous glands to enlarge and produce more sebum. Younger children may have more sebum due to overactive sebaceous glands.
- Plugged hair follicles due to oil and dead skin cells. Sebum may become trapped in the hair follicle and form a sebum plug consisting of dead skin cells, leading to acne breakouts.
- Bacterial and fungal infections. It occurs when bacteria or fungus invades pooled oil inside a pore or hair follicle, leading to infected and inflamed acne.
- Dietary habits. Some food items, especially food with a high glycemic index and some dairy products, may affect the production of sebum, eventually leading to acne breakouts.
- Certain medications. Some medicines, like oral steroids, may overstimulate the sebaceous glands or cause hormonal changes that eventually lead to acne.
- Certain skincare products. Some skincare products may be occlude skin pores and can be comedongenic (cause the formation of black heads and white heads).
- Hereditary and genetics. If a child has a family history of acne, they could be at a higher risk of developing preadolescent acne.
- Mechanical irritation. Acne caused by friction/rubbing–from bed linens, facial masks and textiles, is called acne mechanica.
Forms Of Acne Lesions
Acne can appear in several forms and can appear all at once. The following are the forms of acne lesions one might notice (2).
- Blackheads: These are open skin pores filled with excess oil and dead cells and appear like dirt-filled pores over the skin.
- Whiteheads: These are closed, white- to yellow-colored skin pores clogged with oil and cell debris.
- Papules: These are the reddish or pinkish skin bumps caused by the inflammation of the blocked sebum and skin cells.
- Pustules: It is a pus-filled lesion on the skin. The pus is formed by excess oil and skin debris as well. When picked or scratched, a pustule may leave a scar on the skin.
- Nodules: There are larger acne lesions which are deeper within the skin. They can be filled with pus. Nodules and cysts can be painful and often lead to scarring.
- Cysts: It occurs when there is pus accumulation deep within the skin. It often causes scarring.
Complications Of Acne In Children
The complications of severe and long-standing acne, not only have permanent sequalae on the skin, but also significant psychological effects on the child. The following are common complications of acne (6).
- Lack of self-esteem
- Social withdrawal
- Emotional distress
When To Visit A Dermatologist?
If your child’s acne persists or increases in severity despite gentle skin care, it is always best to consult a board-certified dermatologist. Mild acne can already be bothersome to preadolescent children and you need not wait for acne to be severe before seeking help from a skin expert.
Diagnosis Of Acne In Children
Acne is a clinical diagnosis and oftentimes, no further medical tests are needed. Sometimes, other dermatological conditions such as rosacea and peri-orificial dermatitis, may mimic acne. Hence, when in doubt, it is important to seek advice from a medical expert. In a few special cases, your dermatologist may request certain blood tests to assess levels of hormones to check for precocious puberty and other conditions associated with acne such as polycystic ovarian syndrome.
The doctor may consider the following procedures to determine the underlying cause of acne in a child (7) (8).
- Check for early puberty
- Assess the levels of hormones through blood tests
- Ask about menstrual cycles
- Determine a family history of acne
- Check for the child’s lifestyle and dietary habits
- Check if the child has any medical condition or is on any medication
Treatment Of Acne In Children
The treatment of acne in children will depend on the severity of acne, the child’s age, and if the child has any medical condition. Mild acne may not require any treatment. Acne due to a medical condition or medication is usually cured when the underlying cause is addressed.
Severe preadolescent acne due to hormonal changes may require treatment. The treatment options are similar for children and adults.
The following are the different types of treatment options for acne (1) (9).
- Over-the-counter face wash with benzoyl peroxide and salicylic acid
- Mild face cleansers
- Over-the-counter antibacterial soaps
- Over-the-counter benzoyl peroxide gel
- Healthy nutritious diet
- Sufficient good sleep
- Management of stress
- Vitamin A derivatives
- Anti-inflammatory medicines
- Benzoyl peroxide gels and washes
- Medicines with retinoid acid
The dermatologist may prescribe additional medicines beyond those mentioned above. If you are unsure about the right over-the-counter facewash or soap for your child, speak to the doctor. Never pick, scratch, or pop acne pimples as it may lead to scars.
Natural Home Remedies For Acne
Parents may consider natural home remedies to reduce acne and improve the child’s skin. The following are some natural home remedies for acne. There is no scientific evidence to back these remedies. Therefore, it is best to speak to a dermatologist before trying any of them.
- Aloe vera gel: It is a natural product that soothes the skin and acts as an oil-free moisturizer. You may apply it to acne once a day.
- Honey: It has natural antibacterial properties. You may apply honey to the child’s affected skin once a day.
- Steam: Steam opens the pores, removes dead cells, and moisturizes the skin. Make sure you supervise the child when they take steam to prevent any accidental burns.
- Garlic: It is rich in antioxidants and is considered an antiseptic. You may apply a small quantity of fresh garlic paste to the acne, leave it for a few minutes, and wash it with water.
- Apple cider vinegar: It is known for its anti-inflammatory and antibacterial properties. Dilute a tablespoon of apple cider vinegar in 200ml of water. Soak a cotton ball and apply it to the affected skin. Rinse with plain water.
- Cucumber: Cucumber has high moisture content and is considered to have anti-inflammatory properties. You can blend cucumber into a paste and apply it to the affected skin for a few minutes each day.
Prevention Of Acne In Children
The hormonal changes and the effects of these hormones on sebaceous glands during the preadolescent phase cannot be changed. However, it may be possible to reduce the severity of acne by preventing the buildup of oil and the accumulation of dead skin cells.
The following measures could help prevent acne in children (8) (10).
- Keeping the face’s skin clean
- Avoiding scrubs and exfoliating brushes as these may exacerbate oil production.
- Observing good hair and scalp hygiene
- Always washing away the sweat on the face and other acne-prone areas of the body
- Identifying the skin type, and using suitable moisturizer and sunscreen
- Using oil-free and water-based skincare makeup products
- Avoiding touching acne-prone areas
- Observing careful hair removal procedures
Acne is a common condition during both the preadolescent and adolescent or teenage years. Although acne is a benign condition, it may lead to permanent scarring if not treated early. In addition, it may also have significant psychosocial and emotional effects on the child. If acne is persistent, it is always best to seek medical attention from a board-certified dermatologist.
2. Acne: Overview; Cleveland Clinic
3. What Causes Acne?; American Academy of Pediatrics
4. Pediatric Acne; Children’s National Hospital
5. Treating Teen Acne; Stanford Children’s Health
6. Acne in Children; John Hopkins Medicine
7. Acne: Diagnosis and Tests; Cleveland Clinic
8. 12 Tips to Combat Acne; Rush University Medical Center
9. Acne; C.S. Mott Children’s Hospital
10. Treating pimples; American Academy of Dermatology Association