Infantile (baby acne) and juvenile acne mainly affects male babies of 3 to 24 months of age and may continue up to age of 5 years. The lesion are more localized and commonly affects cheeks. The lesions contain comedones, papules and pustules, and sometime it may include nodules and scarring also. Another disease which is almost same as acne is seen among infants in first 3 weeks of life called neonatal cephalic pustulosis. Here also papules and pustules are seen in cheeks. These are commonly due to Malassezia sympodiales. This is self limiting disease and need no treatment. But topical antifungal creams can be of help.
In one of the study on baby acne and juvenile acne, it was found that about ¼ of patients had mild acne, approximately 60% had moderate acne and remaining had ‘severe acne’ and mean age of onset was 9 months of age. This type of acne are mainly of inflammatory type. The infantile and juvenile acne may be due to transplacental stimulation of adrenal glands because most of the patients have increased adrenal androgens in plasma.
Sebaceous glands in skin have enzymes which can convert adrenal androgens to testosterone and androstenidione. Infantile acne rarely involved with other adrenal disorders like hirsutism. It is not clear why infantile acne or infant acne sometime last for several years. If the child is well and no other abnormal features, than endocrinological investigantions are not required. But endocrine investigations may be required if patient develop acne at the age of 5 to 8 years.
Treatment: Treatment of baby (infantile) acne and juvenile acne consists of same principle for adults. But tetracycline group of antibiotics has to be avoided because it can cause permanent discoloration of dentition (teeth). If disease is mild than topical benzoyl peroxide, retinoid or erythromycin or clindamycin can be used successfully. But retinoid with one antibiotic like erythromycin or clindamycin are preferred. For moderate acne topical retinoid and an antibiotic like erythromycin ethyl succinate 125mg 3 times per day for 6 months can be used successfully. In severe form of infantile acne the treatment is same as moderate but the duration of antibiotic theory has to be much longer. Isotretionin is reserved for patients not responding to standard treatment. Another alternatives is trimethoprime 100mg two times per day.
Patient with baby acne can develop severe acne during adolescence.