Acne by age and when to investigate for endocrine disease

What it is

Acne in childhood is read against age, because the age at which it appears is what decides between reassuring the parents and sending the child for endocrine laboratory testing.

How it presents

• Newborns: as many as 20% of newborns will be affected by neonatal acne, usually in the form of pustules confined to the cheeks, chin, eyelids and forehead. This is typically mild and self-limited.
• Infants: acne can also appear in infants, typically males 6-12 months of age. It is also usually self-limited and not associated with underlying endocrine pathology, in the absence of any other findings suggesting hormonal abnormalities.
• Mid-childhood: acne appearing during mid-childhood is rare.
• Preadolescents and adolescents: very likely to develop acne as a result of normal ovarian or testicular development.

The findings that suggest a hormonal abnormality at any of these ages are clitoromegaly, breast or testicular development, pubic hair growth, hirsutism, or a growth abnormality consistent with increased muscle development.