Management of acne in preadolescents

* Mild acne is characterized by easily recognizable comedones in limited numbers, with or without small papules and/or pustules. Moderate to severe acne is characterized by many comedones and papules and pustules, with or without nodules or cysts.

¶ Topical tretinoin should not be applied at the same time as benzoyl peroxide. If both agents are prescribed, benzoyl peroxide should be applied in the morning and tretinoin should be applied in the evening because tretinoin is less stable when exposed to benzoyl peroxide due to oxidation. Topical retinoids are applied sparingly once daily at bedtime. Benzoyl peroxide gel or cream is applied sparingly once daily in the morning. Benzoyl peroxide wash is used once daily in the morning.

• Doxycycline (children ≥8 years) – 50 or 100 mg twice daily or 150 mg once daily
• Erythromycin – 10 mg/kg/dose, 1 to 2 times daily
• Azithromycin – 5 mg/kg once daily (maximum daily dose 250 mg/day)

◊ Oral isotretinoin is used off-label in children younger than 12 years. Refer to UpToDate topics on acne in infants, young children, and preadolescents for information on isotretinoin administration, dosing, and adverse effects in children.