A clinical and therapeutic study of 29 patients with infantile acne

Background Infantile acne is a relatively uncommon condition; there are few data in the literature on the optimum treatment for this disorder. Objectives To review treatment results in infantile acne. Methods We performed a retrospective review of 29 patients (24 boys and five girls) treated over a 25-year period. Results The age at onset was 6-16 months (median 9). The acne was mild in 24%, moderate in 62% and severe in 14%. The type of acne was predominantly inflammatory (59%), but was comedonal in 17%, showed a mixed pattern in 17% and was nodular in 7%. No infants had any clinically obvious endocrinopathy. Patients with mild acne responded well to topical treatment (benzoyl peroxide, erythromycin and retinoids). All but two infants with moderate acne responded well to oral (paediatric) erythromycin 125 mg twice daily and topical therapy. Patients with erythromycin-resistant Propionibacterium acnes required trimethoprim 100 mg twice daily. Most patients were able to stop oral antibiotics within 18 months. In 38% of children, long-term oral antibiotics (>24 months) were required. The time for clearance of the acne was 6-40 months (median 18). One patient required oral isotretinoin that cleared the acne in 4 months. Five patients (17%) were left with scarring. Conclusions This study confirms the male predominance of infantile acne. Treatment is similar to that of adult acne, with the exclusion of the use of tetracyclines. When necessary, oral isotretinoin can be used.