Practice gaps in childhood acne treatment
It is important to choose the correct therapeutic option when treating pediatric acne.
“There are defined practice gaps among pediatricians, which I believe can be expanded to dermatologists,” says Jonette Keri, M.D., Ph.D., an associate professor of dermatology and cutaneous surgery at the University of Miami in Florida.
Dr. Keri, who gave a presentation on combating acne in children and adolescents at the 2017 South Beach Symposium in Miami Beach in February to an audience comprised of both pediatricians and dermatologists, based her guidelines for acne care from published guidelines in the journal Pediatrics in 2013 and the Journal of the American Academy of Dermatology in 2016.
A practice gap consists of a case test, for which the physician is taught about acne before treatment, immediately after treatment and then three months later, “to see if the doctor is learning to prescribe differently,” says Dr. Keri, in a post-presentation interview with Dermatology Times.
The two defined practice gaps among pediatricians were inadequate use of retinoids in the preadolescent population (ages 8 – 12) and that for severe acne, combination therapies were underused.
Conversely, dermatologists are more likely to prescribe retinoids to preadolescents.
But dermatologists need to heed the second practice gap of combination therapies for severe acne, according to Dr. Keri.
The 2016 guidelines state that oral corticosteroids like prednisone can be used during the initiation of acne therapy in conjunction with other medications such as antibiotics and isotretinoin.
“This protocol can calm down very severe acne,” Dr. Keri observes.
Dr. Keri receives many referrals from dermatologists of children with really bad acne.
“Most of these dermatologists do not seem to consider oral steroids, and the ones who do, often do not use a large enough dose, either too small of a dose or too short of a time” she says.
Dr. Keri treats severe acne similar to acne fulminane (AF), which is explosive acne accompanied with systemic symptoms (fever, bone pain).
“The daily dose of prednisone might be 0.5 mg, even 1 mg, for every kg of body weight of the patient,” Dr. Keri says. For severe acne, a course of treatment can last 2 weeks, 4 weeks or even longer, compared to up to five months for AF.
“Acne patients need to be followed closely to ensure they are doing well on the medication,” says Dr. Keri, chief of dermatology at the Miami VA Healthcare System.