title: Evidence-based recommendations for the diagnosis and treatment of pediatric acne.
abstract: BACKGROUND
  Acne vulgaris is one of the most common skin conditions in children and adolescents. The presentation, differential diagnosis, and association of acne with systemic pathology differs by age of presentation. Current acknowledged guidelines for the diagnosis and management of pediatric acne are lacking, and there are variations in management across the spectrum of primary and specialty care. The American Acne and Rosacea Society convened a panel of pediatric dermatologists, pediatricians, and dermatologists with expertise in acne to develop recommendations for the management of pediatric acne and evidence-based treatment algorithms.
  
  
  METHODS
  Ten major topic areas in the diagnosis and treatment of pediatric acne were identified. A thorough literature search was performed and articles identified, reviewed, and assessed for evidence grading. Each topic area was assigned to 2 expert reviewers who developed and presented summaries and recommendations for critique and editing. Furthermore, the Strength of Recommendation Taxonomy, including ratings for the strength of recommendation for a body of evidence, was used throughout for the consensus recommendations for the evaluation and management of pediatric acne. Practical evidence-based treatment algorithms also were developed.
  
  
  RESULTS
  Recommendations were put forth regarding the classification, diagnosis, evaluation, and management of pediatric acne, based on age and pubertal status. Treatment considerations include the use of over-the-counter products, topical benzoyl peroxide, topical retinoids, topical antibiotics, oral antibiotics, hormonal therapy, and isotretinoin. Simplified treatment algorithms and recommendations are presented in detail for adolescent, preadolescent, infantile, and neonatal acne. Other considerations, including psychosocial effects of acne, adherence to treatment regimens, and the role of diet and acne, also are discussed.
  
  
  CONCLUSIONS
  These expert recommendations by the American Acne and Rosacea Society as reviewed and endorsed by the American Academy of Pediatrics constitute the first detailed, evidence-based clinical guidelines for the management of pediatric acne including issues of special concern when treating pediatric patients.
authors: Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego and Department of Pediatrics, University of California, San Diego, San Diego, California, USA. leichenfield@rchsd.org
authors: Lawrence F
authors: LF
authors: Eichenfield
authors: Andrew C
authors: AC
authors: Krakowski
authors: Caroline
authors: C
authors: Piggott
authors: James
authors: J
authors: Del Rosso
authors: Hilary
authors: H
authors: Baldwin
authors: Sheila Fallon
authors: SF
authors: Friedlander
authors: Moise
authors: M
authors: Levy
authors: Anne
authors: A
authors: Lucky
authors: Anthony J
authors: AJ
authors: Mancini
authors: Seth J
authors: SJ
authors: Orlow
authors: Albert C
authors: AC
authors: Yan
authors: Keith K
authors: KK
authors: Vaux
authors: Guy
authors: G
authors: Webster
authors: Andrea L
authors: AL
authors: Zaenglein
authors: Diane M
authors: DM
authors: Thiboutot
mesh_terms: D000152:Acne Vulgaris / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy*; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003937:Diagnosis, Differential; D019317:Evidence-Based Medicine; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012176:Retinoids / Q000009:adverse effects / Q000627:therapeutic use; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents; D003879:Dermatologic Agents; D012176:Retinoids
keywords: AARS; American Acne and Rosacea Society; acne algorithm; acne guidelines; acne treatment; bacterial resistance; benzoyl peroxide; combination acne therapy; hormonal therapy; infantile acne; isotretinoin; mid-childhood acne; neonatal acne; pediatric acne; preadolescent acne; retinoids