Differential diagnosis
It is important to differentiate infantile acne from other forms of acneiform eruptions. Acne venenata infantum is a form of acne characterized by comedone formation and induced by chemical irritants on the skin. This can include comedogenic products such as lotions, ointments, creams and oils. Upon discontinuation of these products, lesions will heal within 6–8 weeks.Other conditions that should be considered include periorificial dermatitis, keratosis pilaris, sebaceous hyperplasia and infections. Pyodermas and panniculitis should be considered in severe cases of inflammatory acne or in cases of acne conglobata while hyperandrogenism should be ruled out in cases of persistent infantile acne. Treatment
Infantile acne 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 infantile acne 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 infantile acne 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.
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.