Infants, children, or adolescents with severe, recalcitrant, or scarring acne should be referred to a specialist for more aggressive intervention. For adolescents with nodulocystic acne (severe acne characterized by inflammation, nodular breakouts, and cysts), early intervention with systemic therapies, including isotretinoin, is important to prevent scarring. Also refer patients to dermatologic surgeons for further evaluation and management if their acne causes them psychological distress, whether or not their clinical presentation is severe.
Dr. Sikora is a private practice dermatologist in Chestnut Hill, Mass., and a member of many professional organizations, including the American Society for Dermatologic Surgery (www.ASDS.net) and the American Academy of Dermatology. Dr. Sikora said she had no relevant financial disclosures.