In a 6-year-old child with non-inflamed papules, does acne have to be red and inflamed?

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Ne, akne ne moraju uvijek biti crvene i upaljene

Akne vulgaris mogu se prezentirati kao neupaljene lezije (komedoni) ili upaljene lezije (papule, pustule, noduli), a dijete od 6 godina s neupaljenim papulama može imati komedone koji su karakteristični za akne. 1

Klinička prezentacija akni

Prema najnovijim smjernicama American Academy of Dermatology iz 2024. godine, akne vulgaris se definiraju kao kronična, upalna bolest kože pilosebacealnih jedinica koja se primarno prezentira sa:

  • Otvorenim ili zatvorenim komedonima (neupaljene lezije)
  • Papulama, pustulama ili nodulima (upaljene lezije)
  • Mogu rezultirati bolom, eritemom, hiperpigmentacijom ili ožiljcima 1

Važna napomena o neupaljenim lezijama

Komedoni (neupaljene lezije) su legitimna i česta prezentacija akni, posebno u ranim fazama bolesti 2. Kod pacijenata s različitim tonovima kože, komedoni boje kože mogu biti teški za uočavanje, što može dovesti do pogrešne ili odgođene dijagnoze 2.

Posebne razmatranje za dijete od 6 godina

Upozorenje o akni u srednjem djetinjstvu

Akne u dobi od približno 1-6 godina su izuzetno rijetke i liječnici bi trebali biti sumnjičavi na osnovne sistemske bolesti 3. Ova dob spada u kategoriju "mid-childhood acne" koja zahtijeva poseban pristup:

  • Prepubertalne akne u ovoj dobi mogu ukazivati na hiperandrogenemiju 4
  • Potrebna je daljnja obrada kako bi se isključila osnovna bolest 3
  • Razmotriti upućivanje dječjem endokrinologu kako bi se isključio prijevremeni pubertet i tumori kao uzrok prepubertalnih akni 3

Patogeneza u različitim dobnim skupinama

Mikrokomedoni, najranije lezije akni, obično se pojavljuju pri adrenarhi, što se tipično događa oko 8 godina života kada androgeni adrenalnog porijekla počinju stimulirati folikularnu hiperkeratozu 5. Komedoni se pojavljuju oko 2 godine kasnije 5.

Praktični pristup

Za dijete od 6 godina s papulama:

  1. Pažljivo pregledajte lezije - jesu li to zaista komedoni ili nešto drugo?
  2. Tražite znakove hiperandrogenemije - prijevremena pubarha, akselarna dlaka, ubrzani rast
  3. Razmotriti diferencijalnu dijagnozu - keratosis pilaris, folikulitis, druge folikularne dermatoze 6
  4. Ako su prisutne prave akne u ovoj dobi, potrebna je endokrinološka evaluacija 3

Ključna zamka

Ne pretpostavljajte da sve papule na licu djeteta moraju biti crvene i upaljene da bi bile akne - komedoni su validna prezentacija, ali u dobi od 6 godina zahtijevaju dodatnu evaluaciju za isključivanje endokrinih poremećaja 2, 3.

References

1
Guideline

guidelines of care for the management of acne vulgaris.

Journal of the American Academy of Dermatology, 2024

4
Research

Acne vulgaris in children and adolescents.

Minerva pediatrica, 2011

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