Preteen Acne Treatment Singapore
"My Daughter is 9 and has acne. Can it be treated?"
Although the prevalence of acne is highest in the teenage group (more than 12 years of age), acne can occur at all ages. A study revealed that acne is present in up to 78% of girls aged 9 to 10. Acne may be the first sign of puberty in both boys and girls.
Acne is considered a chronic inflammatory condition of the pilo-sebaceous glands. Acne is hormonally driven, and causes an excess in sebum oil production and abnormal skin cell turnover. This creates an ideal environment for the colonisation of the P.acnes bacteria and inflammation to take place. Left untreated, acne can progress to more severe forms such as cystic acne, and can leave permanent acne scars.
The American Academy of Pediatrics has recently published guidelines on the treatment of acne in the paediatric population, given how common the condition is in this age group.
How Is Preteen Acne Different From Adult Acne?
Preteen acne tends to be concentrated along the 'T zone area'. The forehead, nose, mid cheeks and chin tend to be affected by mainly clogged pores, whiteheads and blackheads. The back is usually the last to be affected if any at all. Inflammatory acne lesions are less common in this age group. However, whiteheads left unchecked has a higher tendency to progress to inflammatory acne. One special feature is the presence of blackheads in the ear, which many mistaken for dirt, leading to over zealous cleansing.
Adult acne tends to follow a "U-Shape" pattern, with acne lesions being distributed along the jawline, chin and cheeks. The inflammatory component is more visible in this age group, and are characterized by painful papules, pustules or even deep seated acne cysts.
3 Tips to Fight Preteen Acne
- Use a 2% salicyclic acid-based wash if you find the skin to be very oily,
- Avoid over-washing your face more than 3 times a day, as this can lead to more oil production and consequently more acne.
- Over the counter Benzoyl Peroxide products are useful and can treat mild forms of acne.
Can Preteen Acne Be Treated?
There are several factors to consider with regards to preteen acne treatment. The predominant acne type (whether comedomal, inflammatory or mixed), the severity (mild, moderate or severe), presence of acne scarring and whether the acne is causing psychological distress.
Preteen acne has its unique challenges. The treatment regime needs to be simple enough to follow, yet effective. Medications must be safe to use, yet side effects minimised. Patient education must be positively reinforced, and myths dispelled at the same time.
Preteen Acne Treatment
The best treatment for preteen acne depends on the predominant acne type, and how severe the acne is affecting the child.
For mild acne, topical combination acne products are more effective and have a synergistic effect. Epiduo gel is a combination of the retinoid adapalene with benzoyl peroxide. Together, they exert an anti-inflammatory effect, unclog pores and kill the P. acnes bacteria. It is approved for use in patients as young as 9 years of age. It is common for the product to cause some intial skin redness, irritation and peeling. A gradual approach to application helps increase the acceptance in incorporating the treatment into daily use.
In cases of moderate to severe acne, the goals of treatment is more directed towards reducing inflammation and reducing permanent skin scarring. Treatment is more aggressive, and an oral antibiotic may be added on top of topical acne products. The tetracycline class of antibiotics are only approved by children more than 8 years of age. Antibiotics may cause gastric disturbances such as vomiting, bloatedness, reflux and diarrhoea. The shortest course of oral antibiotic is usually prescribed, as the risk of antibiotic-resistant acne is on the rise worldwide.
3 More Tips For Parents & Patients
- Set reminders on your phone to apply or take your medicine. Consistent use will give superior results.
- Don't spot treat. Acne frequently pops out areas that are not treated. Full face treatment should be the norm once you have established a simplified skin care routine.
- Patience. Everything is difficult before it is easy. It takes weeks to see some improvement, and 2-3 months before you see the full effect of the treatment.
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- Zaenglein et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74:945-973.e933
- Eichefield et al. Evidence-Based Recommendations for the Diagnosis and Treatment of Pediatric Acne. Pediatrics.2013;131(Suppl 3):S163-S186