Topics in Acne  Acne in childhood  Acne in adulthood  Acne in pregnancy  Acne in ethnic skin  Updates on isotretinoin Acne in Childhood  Neonatal acne Acne in Childhood  Neonatal acne  a.k.a. neonatal cephalic pustulosis  Occurs in first month of life (peak week 2-3)  Seen in up to 20% neonates  More common in males  Papules and pustules on face Primarily cheeks; can be on trunk too   Maternal hormones thought to increase sebum production in early life  May actually be due to malassezia species Has been cultured from pustules, but may just be resident flora?   Not predicative of future acne Acne in Childhood  Neonatal acne  Treatment None: usually resolves rapidly (within days)  Treat possible malassezia etiology  Topical ketoconazole 2% BID for 1 week  Acne in Childhood  Infantile acne Acne in Childhood  Infantile acne  Occurs at 3-6 months of age  Grouped comedones, papules, and pustules  Due to “hormonal imbalance” Elevated LH from testes in boys  Elevated DHEA from adrenal (boys and girls)   May be a precursor of bad teenage acne; may have strong family history Acne in Childhood  Infantile acne  Hormones stabilize by about 12 months  Treatment None: many cases resolve by age 1-2  Most will need treatment:  UK study of 29 pts found that majority had inflammatory acne  that required >1 year of therapy Topical retinoids and benzoyl peroxide  Emycin 125mg BID or TMP-SMX 100mg BID  Isotretinoin in severe nodulocystic cases  Acne in Childhood  Scarring  Treatment is usually addressed b/c even minor acneiform lesions can cause long-term sequelae Acne in Adulthood