Acne occurs primarily in the first year of life and at puberty. Neonat
al and infantile acne may reflect the relatively high androgens from t
he adrenal in girls and the adrenal and testes in boys characteristic
of this age. Early in puberty acne in boys and girls is primarily come
donal and midfacial. The best predictors of severe acne are early onse
t of comedones and serum levels of dehydroepiandrosterone sulfate. Ear
ly recognition and therapy of acne may prevent scarring and psychologi
cal stress.