During the first 6–12 months of age, there is increased sebum production stimulated by luteinizing hormone (LH) and testosterone of testicular origin that stops after this period until adrenarche. Girls do not experience this.Genetics and family history play a role in influencing sebaceous gland size and activity, pore size and inflammation that can increase risk of onset and presentation of infantile acne.It is suggested that the fetal adrenal gland along with testicular androgen could be the cause of infantile acne. During the neonatal period, there is increased sebum production through an enlarged zona reticularis (an androgen producing area) on the fetal adrenal gland that gradually decreases to very low levels at around 1 years of age, coinciding with when infantile acne tends to resolve. The fetal adrenal gland produces androgens such as dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEAS) that stimulate sebaceous glands. Diagnosis
Diagnosis is based on presentation of comedones primarily on the face of an infant of 6–12 months of age. Severity can be mild, moderate or severe and can be determined from the presence and distribution of comedones and inflammatory lesions such as papules and nodules. A physical may be followed up next with particular attention paid to signs of an endocrine disorder including normal growth and weight, testicular growth, breast development, hirsutism or growth of pubic hair. Hormonal workup may not be necessary unless one of these abnormalities is present, then work up of testosterone, DHEA, DHEAS, LH and FSH or referral to a pediatric endocrinologist specialist may be recommended.
Infantile acne is a form of acneiform eruption that occurs in infants from 6 weeks to 1 year of age. Typical symptoms include inflammatory and noninflammatory lesions, papules and pustules most commonly present on the face. No cause of infantile acne has been established but it may be caused by increased sebaceous gland secretions due to elevated androgens, genetics and the fetal adrenal gland causing increased sebum production. Infantile acne can resolve by itself by age 1 or 2 however treatment options include topical benzyl peroxide, topical retinoids and topical antibiotics in most cases. Signs and symptoms
Infantile acne has a later onset and is less commonly seen than neonatal acne, occurring between 6 weeks to 1 year of age. It is also more commonly seen in boys rather than girls. Infantile acne tends to be more inflammatory and wide spread than neonatal acne. It presents with both open and closed comedones, papules and pustules. Cystic lesions are uncommon. Scarring can occur in severe cases. Very rarely, facial conglobate acne, a severe form of acne that involves extensive inflammation and nodule formation can develop and lead to extensive scarring. Lesions occur most commonly on the cheeks but can also appear on the chest and back. More severe occurrences may lead to development of more severe forms of acne in adolescence. Causes
The cause of infantile acne is not known for certain. Research into higher occurrence in boys rather than girls imply that higher than normal levels of testicular androgens can cause increased sebaceous gland secretions.