Acne is often seen as a condition that just plagues teenagers, but acne doesn’t just affect adolescents it’s a problem that can appear in younger children and even babies. With a shortage of dermatologists generally in the country, and with young children not being able to avail of all treatments, what can parents do if their child falls victim to blackheads, pustules and angry red skin?
As it happens, childhood acne has been under observation for some time. A study published in the British Journal of Dermatology in 2001 stated that acne affects 10.8 per cent of children aged 5-13. Acne can also appear in babies but is usually transient, the result of maternal hormones and is not harmful, but acne also sometimes appears in children aged 3-9 years.
Consultant Dermatologist, Dr Fiona Browne at CHI, Children's Health Ireland, Crumlin, says acne in this age group is considered a "red flag" and children should be referred to an endocrinologist to try and see if there are underlying hormonal problems while topical outbreaks will also be treated. Dr Browne adds that these days it's not rare to see children 10-12 years with 'severe acne' in Ireland.
Treating children also presents some challenges.
“Tetracycline antibiotics are not recommended for under the age of 12 so we really only have one class of antibiotics (erythromycin),” she says.
'Parent and child expectations are ever increasing, also there's more education/information out there'
There are several reasons why children might be presenting more for treatment today, according to Dr Browne. “Acne typically only occurs in the prepubertal-adolescent year when seborrhoea/grease production is at its peak,” but it seems the prepubertal adolescent years are expanding.
“It’s getting younger all the time – any time from eight really,” she says. In addition, “parent and child expectations are ever increasing, also there’s more education/information out there so parents know there are treatments available,” she adds.
Dr Naomi Mackle, a GP with a specialist interest in dermatology, concurs that treating children who present with acne ahead of peers is no longer unusual. In Dr Mackle's Adare Clinic, based in Limerick and Dublin she too has treated children aged ten years and upwards for skin problems.
“In 10- to 11-year-olds you’ll typically start with something like a salicylic cleanser; then, if needed, you might move onto a topical antibiotic. In children antibiotics (oral) have to be used with care, not all are suitable before puberty as they can interfere with bone structure,” she says.
It can be the case that sometimes young patients just need to get into a proper cleaning regime to get good skincare results; The Adare Clinic recommend products on their website, but sometimes in rare cases something more hard-hitting is required, say Dr Mackle.
Roaccutane is sometimes seen as the end game drug for acne when nothing else works and Dr Mackle says she has prescribed it to a younger child. It can, she says, be taken at a very low dose.
“There was one boy, in his 12th year who had quite severe acne and there was a family history there, he’d older siblings with acne and I felt Roaccutane in his case was the right choice. I am very aggressive in my treatment of acne but very ethical. I see the other side of acne, 40 per cent of our consultations are for some sort of acne treatment and the treatments to get perfect skin again can be expensive, prevention of problems if you can, is always better,” she says.
Acne sufferers who’ve controlled their breakouts can get treatments to improve appearance ranging from needling, to different kinds of peels and laser. Not all treatments are suitable for children, but Dr Mackle says she’s used peels on 13-uear-olds and that needling can be done on 12- and 13-year-olds.
'I can definitely see how it'd have a profound impact on self-esteem'
“You can do needling on a child if they can tolerate it, though we use anaesthetic here (topical numbing cream) ... micro needling in younger people can give good results in that their skin is good at producing collagen, but thankfully, usually by age 12 there’s no established scarring,” she reassures.
However Dr Mackle says she wouldn’t let acne in children go untreated because after years of breakouts there’d be more accumulated damage.
Fortunately, Dr Mackle believes today’s parents better understand the psychological and physical effects of acne and are not likely to brush the condition off as something a young person will “just grow out of”.
“I’d acne myself as a young person and I understand that acne can be devastating for young people’s confidence”, she says.
Dr Fiona Browne agrees that acne can, "have a huge impact on quality of life and self esteem and this can be particularly bad when they (patients) present ahead of or after peers". The psychological impact of acne was also recently explored by psychologist, Jamie Davern at University of Limerick. His online survey of 276 students showed that amongst sufferers "perceived stigma" was the most important marker for quality of life. The study also showed girls were, "more likely to experience psychological distress".
Although his subjects were 18 years or over, Mr Davern believes, “it’d be interesting to see psychological studies on the effect on younger kids. ‘”I was surprised to see from previous studies that such a large amount of children suffer and I can definitely see how it’d have a profound impact on self-esteem and be difficult for parents to manage given lack of treatment options and general awareness.”
The UL study findings suggest interventions to counter stigma could be done earlier to help build confidence. “Introducing classes at primary level that teach strategies on how to cope with stigmatisation could prepare young people for the inevitable increase in the scrutiny of their physical appearance.”
Mr Davern also thinks the media could also help more with social acceptance, “It’s not the norm to see people or children with acne on TV or in advertisements which is somewhat strange compared to how much we now see people with other difficulties and challenges being represented,” he argues.
