Is Acne Becoming A Kids’ Disease?
Everybody knows that teens get acne. Nearly everyone now an adult remembers getting blackheads, whiteheads, pimples, and other kinds of zits as a teenager. But there is a disturbing recent trend of acne in children as young as 7 up to the age of 12.
Dermatologist Latanya Benjamin of the Lucille Packard Children’s Hospital at Stanford University in California told a New York Times reporter1 that, in her practice, it is not uncommon to see blackheads and whiteheads on the faces of children aged from 7 to 9. Dr. Benjamin attributes this new trend to a change in the average age of adrenarche, the maturation of the adrenal glands.
In the modern world, children’s adrenal glands, perhaps due to the overstimulation posed by video games, television, and pressures to succeed at an early age in school, start producing stress hormones in adult quantities earlier and earlier. Exposure to xenobiotics, artificial hormones from the environment, and high-fat diets are also inducing precocious puberty2. Children begin to have functioning sex organs as early as 8 or 9. The earlier onset of sex hormones also causes earlier onset of acne3.
How Much Earlier?
A study published in the medical journal Annals of Dermatology4 two years ago stated that the average age of a non-adult patient brought to the dermatologist for acne care had declined from 15.8 to years to 15.0 years. In other words, the average age of children and teens affected by acne has fallen about 10 months.
But the proportion of children taken to the doctor to get treatment for acne has risen dramatically. At one time, dermatologists almost never provided acne care to children who were not at least in the sixth grade. Now, most dermatologists routinely treat acne in children who are in the third grade. And 1.5% of all acne care visits are for seven-year-olds.
What can parents possibly do to protect their children from acne? Here are some suggestions.
- Be ready for drama. A pimple popping up just before a party is just as big a deal for a seven-year-old as it is for a seventeen-year-old, or maybe bigger, because a seven-year-old is exposed to a lot more teasing.
- See the doctor. Most of the time, routine acne care works just as well for elementary school-aged acne sufferers as it does for those in middle school, high school, and college. But you need to know just how much treatment will be required to prevent acne scarring.
- Don’t stop treatment when blemishes clear up. Make sure your child has the treatments needed to avoid the brown spots that often follow acne, especially in children who have golden or deep brown skin tones. The skin repairs damage with the antioxidant pigment melatonin. When the acne is gone, the pigment stays behind, especially if the acne-affected skin is also exposed to the sun. Sunblock, caps, and hats can be just as important to treating acne as antibiotics and anti-acne drugs.
- Just say no to tetracycline. Although it doesn’t happen every time tetracycline is prescribed, many children who are just getting their permanent teeth can have a problem with blue- or black-stained enamel5 if they are given tetracycline or minocycline when teeth are growing rapidly. An astonishing number of family physicians are unaware of this potential complication of antibiotic treatment. A study in the journal Pediatric Dermatology reported that just in the United States, over 120,000 children per year are inappropriately prescribed minocycline or tetracycline.
It’s typically your family practitioner who will offer antibiotics for acne in childhood. The dermatologist is far more likely to recommend a combination of benzoyl peroxide and one of the vitamin A derivatives known as retinoids6, especially Roaccutane, Retin-A, or Differin. Your family practitioner is more likely to prescribe a pill—the form of acne medication that is most likely to have side effects—while your dermatologist is more likely to prescribe a skin cream or gel—which costs more.
Health insurance in the USA doesn’t cover a lot of the medications doctors like to prescribe for children who have acne. Roaccutane, Retin-A, and Differin, for example, are “off-label” for use in treating children under the age of 12. Your health insurance may balk at paying for them. However, all insurance plans will pay for the relatively new anti-acne product called Epiduo, which is a combination of Retin-A and benzoyl peroxide.
Epiduo has been clinically tested on children as young as 9, so the US Food and Drug Administration has approved its use on children7. The downside to using the product is that it can make growing skin itchy and even actually hurt. When this happens, the doctor is likely to suggest a milder product that the FDA has not approved, but which has fewer side effects on rapidly growing skin.
Some natural products are not a good idea for kids, either. Tea tree oil, the Australian herbal extract, is a great product8 for treating acne in adults. It gets rid of acne bacteria faster than the most commonly prescribed medication for acne, benzoyl peroxide, and it relieves inflammation and itching, too.
Unfortunately, tea tree oil also interferes with hormonal balance9 in the bodies of children who have not yet passed puberty, especially the bodies of prepubescent boys. It interferes, in some cases, with the body’s use of estrogen, encouraging the growth of breast tissue.
When this happens to elementary school-aged girls, it’s a social concern. When this happens to elementary school-aged boys, it’s a social disaster. The effects are reversible when tea tree oil products are discontinued, but the “breastiness” of the chest diminishes as other tissues grow normally around the breasts. It can take several months to undo the effects of tea tree oil compresses and tea tree oil soaps. This is not by any means a common complication of the use of tea tree oil in pre-adolescent children, but it’s common enough that no parent should ever use a tea tree oil acne care product on any child who has not yet passed through puberty.
- Catherine Saint Louis. Younger Children Seek an Acne Cure, NY Times, May 20, 2013.
- Ullah R, Su Y, Shen Y, Li C, Xu X, Zhang J, Huang K, Rauf N, He Y, Cheng J, Qin H, Zhou YD, Fu J. Postnatal feeding with high-fat diet induces obesity and precocious puberty in C57BL/6J mouse pups: a novel model of obesity and puberty. Front Med. 2017 Jun;11(2):266-276.
- Förström L. The influence of sex hormones on acne. Acta Derm Venereol Suppl (Stockh). 1980;Suppl 89:27-31.
- Jamie L. Goldberg, Tushar S. Dabade, Scott A. Davis, Steven R. Feldman, Daniel P. Krowchuk, Alan B. Fleischer. Changing Age of Acne Vulgaris Visits: Another Sign of Earlier Puberty? Pediatric Dermatology Vol. 28 No. 6 645–648, 2011
- Raymond J, Cook D. Still leaving stains on teeth-the legacy of minocycline? Australas Med J. 2015 Apr 30;8(4):139-42.
- Kim SY, Ochsendorf FR. New developments in acne treatment: role of combination adapalene-benzoyl peroxide. Ther Clin Risk Manag. 2016;12:1497–1506. Published 2016 Oct 3.
- U.S. Food and Drug Administration Center for Drug Evaluation and Research Office of Surveillance and Epidemiology. Pediatric Postmarketing Pharmacovigilance Review. December 21, 2017 Reference ID: 4199198
- Enshaieh S, Jooya A, Siadat AH, Iraji F. The efficacy of 5% topical tea tree oil gel in mild to moderate acne vulgaris: a randomized, double-blind placebo-controlled study. Indian J Dermatol Venereol Leprol. 2007 Jan-Feb;73(1):22-5.
- Henley DV, Lipson N, Korach KS, Bloch CA. Prepubertal gynecomastia linked to lavender and tea tree oils. N Engl J Med. 2007 Feb 1;356(5):479-85.
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