INTRODUCTION
While part of its name, vulgaris, reflects the very fact that it
is common, acne vulgaris is much less common in babies, toddlers,
or preadolescents. In most individuals at a variety of
ages acne vulgaris is not subtle, and a preteen or teen presenting
with comedones, pustules, and inflammatory papules
on his or her face is considered to have acne until proven otherwise.
There is a good understanding of the basic pathophysiology
of acne, and multiple algorithms have been
developed to help assist practitioners in composing successful
treatment regimens. The pharmaceutical, cosmetics, and
cosmeceutical industries have recognized acne as an important
consumer concern, supporting the development of a
myriad of treatment products from which to choose a therapeutic
strategy for individual patients.
However, especially when presenting in infancy and childhood,
acne may not be straightforward and can be of great
consequence. It may cause serious sequelae including severe
scarring and emotional distress1,2 (in both the child and parents),
and its treatment has fueled concerns about contributing
to the public health threat of increased antibacterial
resistance.3 It can present much earlier than expected, and it
can resemble a number of other inflammatory and noninflammatory
dermatoses (Figure 1).4 The myths and conjectures
that circulate regarding cause and exacerbators of acne
have been a source of consternation for patients, families, and
practitioners alike.5 The young pediatric acne patient shows
that some of our knowledge regarding pathogenesis is limited.
Similarly, treating acne is not always as easy as mail order
companies make it seem with 3-step products. Conscientious
healthcare providers run into the daily problem of choosing
acne weapons that are highly effective with the least amount
of collateral ill effects.
Epidemiology
Acne vulgaris is near universal in adolescents and young
adults in the western world, with an incidence of greater than
80% in people aged 11 to 30 years.6 It has been estimated that
newborns are affected with up to 20% prevalence in the first
few weeks of life, though it is uncertain if the reported eruptions
eruptions
are all true acne.7 The next and much less commonly
affected population is infants, generally between 6 and 16
months of age.8 Mid-childhood acne, seen in those children
between 1 and 7 years of age, is rare though few scattered
comedones are occasionally observed in this age group.9,10
The incidence of acne vulgaris rises in the next subset of patients
with prepubertal acne, which can have age of onset
around 8 years old.11
