Acne for Pediatricians

There will be two speakers for this section. I'll talk about topical medications, and at the conclusion of my talk, Dr. Hansen will speak about systemic medications for the treatment of acne. I'm going to hit on some old standbys and look at their ups and downsides, and I'm going to talk about some of the enhanced topical benzoyl peroxides, topical retinoids, etc. that can be used in acne that may be less irritating to kid's skin. We're also going to demonstrate an in-office educational technique dealing with the adolescent or preadolescent with acne in your office; how to explain acne to them, and what you're going to use, and a take-home sheet which is also in your handout, one that I use in my office, which I feel if you start using next Tuesday in the office, you're going to improve compliance and get better efficacy in what you're using for your acne patients.

How Do You Know You Have Acne?

None of you have any problems diagnosing acne, this is never an issue, right? Except maybe in a situation like this where the old doctor is asking the hirsute patient, How do you know you have acne?

It's fun to joke, but this guy, his acne is no joking matter, and you wonder about bullying and isolation.

In fact, here is what teens thing: more than 40% of teenagers consider people with acne less desirable; one-third of all teenagers think that people with acne are definitely less popular and cool to hang with.

Four out of five teenagers incorrectly believe that acne is caused by dirt, and about eighty percent think that acne can be washed away. Most teenagers believe that acne can be cured, but only seven percent of them go to a dermatologist. That means that ninety-three percent of them are in the hands of the pediatric healthcare provider.

There is no reason in 2003 for any child to have to end up with this type of physical appearance, and the physical and psychological scarring that can afflict them for the rest of their life because their acne was not adequately treated, it's just avoidable almost every time.

Acne Pathogenesis

This is a disease that people break into four possible pathogenesis, we'll talk a little bit about the fact that an anatomical alteration, a block of the canal that goes from a sebaceous gland to the skin gets blocked up, causes comedones and the fact of p. acnes giving inflammation, papules, pustules, nodules and cysts.

Acne Staging

Some people try to stage acne. One way to do it is the following: comedonal acne: the whiteheads and blackheads, and we think more about the topical retinoids and some of the benzoyl peroxide preparations for that, certainly no need for systemic medication. Stage 2, whatever you have in stage 1, and you add some inflammatory lesions, like papules and pustules. Well now for sure you want to add a benzoyl peroxide type product, maybe if it's a little more extreme, maybe a systemic, but probably a topical antibiotic would suffice. Stage 3, everything in 1 and 2, but now a larger number of more severe lesions, and now it's time for oral medications. And stage 4, nodulocystic, well you try all the topicals, all the systemics, and you may end up either with oral birth control in a female patient or Accutane in either male or female, and we'll leave that to Dr. Hansen.

Stage 1

Stage 1, mainly comedonal, topical retinoid, maybe a benzoyl peroxide product.

Stage 2

Mild stage 2, a combination of retinoid and benzoyl peroxide, maybe a topical antibiotic.

Stage 3

Stage 3, we need a systemic antibiotic.

Stage 4

Stage 4, try everything, but don't be surprised if you end up on either a birth control in a female, or Accutane in a male or a female.