<unk>  is a self-limiting condition that resolves by itself within 6–12 months of occurrence or occasionally by ages 4–5 and does not require treatment in most cases but topical therapies can be used, especially in more severe cases. The goals of treatment are to reduce sebum production, prevent formation of microcomedones, suppress the growth of bacteria and reduce inflammation. As there are no US FDA approved medications for treatment of<unk>  due to lack of high quality trials in patients under 9, recommendations for treatment is based on observations in adult and adolescent populations. Benzoyl peroxide Benzoyl peroxide (BPO) is first line for mild cases of<unk>  due to its safety and effectiveness. BPO concentrates within cells of sebaceous follicles where it generates free radicals to oxidize proteins in bacteria such as P. acnes. This leads to bacterial death. It additionally works as a mild comedolytic and anti-inflammatory. No bacterial resistance has been reported from BPO usage and in fact it can help limit resistance to antibiotics. Common side effects include burning, stinging, scaling and dryness at the sight of application and can be managed by reducing quantity applied, frequency of application, using a less potent product and use of non-comedogenic moisturizers. Retinoids Topical retinoids both alone and in combination are also first line for treating mild to moderate cases of acne. Safety and efficacy has been demonstrated in individuals 12–18 years of age. Retinoids prevent formation of comedones and promote comedolysis by binding to retinoic receptors and normalizing growth of keratinocytes. Tretinoin and adapalene have demonstrated efficacy in reducing inflammation. Adapalene as a newer retinoid is thought to be more effective and better tolerated than others in this class. As a topical product, it has similar side effects to topical BPO of burning, stinging, drying and scaling which can be managed much the same way. Reducing the potency of initial treatment, using a non-comedogenic moisturizers, and applying a small amount on the whole face rather than spot-treating may reduce severity of side effects. In severe cases, oral isotretinoin may be recommended to prevent scarring. Dosing ranges from 0.2 mg/kg/day to 2 mg/kg/day for several months to over a year with careful monitoring. Monitoring may include complete blood count with differential and baseline liver function and lipids tests followed by routine liver function and lipid tests while on treatment. Antibiotics Topical antibiotics Topical antibiotics are often used in cases of inflammatory<unk>  in combination with another topical treatment to prevent emergence of antibiotic resistance especially for periods longer than a few weeks. Clindamycin and erythromycin are the most commonly prescribed topical antibiotics for acne with coverage for S. aureus and P. acnes. These bacteriostatic antibiotics interfere with bacterial protein synthesis, preventing formation of free fatty acids by these bacteria that cause inflammation. Oral antibiotics In severe cases of<unk> , especially with the presence of nodules and cysts with risks of scarring, oral antibiotics may be used. First line therapy is erythromycin with sulfamethoxazole-trimethoprim as a secondary choice in cases of P. acnes resistance. It is suggested not to use tetracyclines due to risks of permanently staining teeth in children under the age of 7. Side effects of erythromycin include gastrointestinal upset. There has however been concerns about resistant P. acnes due to widespread usage of antibiotics, and therefore steps taken to minimize resistance such as use in combination with BPO is highly recommended by experts.
Infantile acne
Pomade acne
Neonatal acne
Feline acne
Tropical acne
Acne cosmetica
Occupational acne
Ichthyosis vulgaris