Baby acne

Baby acne also called acne neonatorum or infantile acne, can occur anywhere on baby’s face, but is usually seen on the cheeks, nose, chin and forehead. Babies can develop blemishes on their face that looks exactly like acne commonly seen in teens. Baby acne can be present at birth but usually develops around 3 to 4 weeks of age. Although the cause of baby acne is unknown, baby acne may be the result of maternal or infant hormones (androgens) stimulating glands in the baby’s face skin to produce oil, or sebum. Baby acne can look worse when the baby is crying or fussy, or any other instance that increases blood flow to the skin. Baby acne is harmless and usually resolves on its own within several weeks. Males tend to be more affected than females, although this reason is unknown. Baby acne usually clears up on its own, without scarring.

Baby acne can essentially be divided into 2 groups:

1. Neonatal acne, which affects babies in their first month of life. Neonatal acne occurs in about 20% of newborns.
2. Infantile acne, which typically affects babies 3–16 months of age. Infantile acne appears to be less common.

Neonatal acne that is confined to the face is called benign cephalic pustulosis, while infantile acne is usually more severe than neonatal acne and consists of more lesions. Infantile acne form may last a few weeks to a few months, but most cases usually resolve by age 3.

Don’t try any over-the-counter medications without checking with your baby’s doctor first. Some of these products may be damaging to a baby’s delicate skin.

In mild cases of baby acne, using a daily cleanser is usually the first step in treatment. Gentle, fragrance-free cleansers are best and should be applied to the affected area daily. Newborns and infants have very sensitive skin, so vigorous scrubbing should be avoided.

Infantile acne

True infantile acne generally affects the cheeks, and sometimes the forehead and chin, of children aged six weeks to one year. It is more common in boys and is usually mild to moderate in severity. In most children it settles down within a few months.

Infantile acne may include comedones (whiteheads and blackheads), inflamed papules and pustules, nodules, and cysts. Infantile acne may result in scarring.

What is the result of infantile acne?

Severe infantile acne may result in permanent scarring ¹. Individuals with severe infantile acne tend to develop troublesome acne at puberty.

What is the cause of infantile acne?

The cause of infantile acne is unknown. It is thought to be genetic in origin. It is not usually due to excessive testosterone or other androgenic hormones and children with infantile acne are usually otherwise quite normal in appearance.

Acne is rare in older prepubertal children aged 2 to 6. It is associated with higher levels of androgens than is expected for the age of the child. These may result in virilisation. Signs of virilisation are:

• Excessive body hair
• Abnormal growth
• Genital and breast development
• Body odor.

Hormone abnormalities in children with acne may be associated with the following conditions:

• Congenital adrenal hyperplasia
• Cushing syndrome
• 21-Hydroxylase deficiency
• Precocious puberty
• Androgen-secreting tumors
• Medications
• Premature adrenarche (early puberty).

Should any tests be done?

In most babies with acne, no investigations are necessary. In older children, or if there are other signs of virilisation, the following screening tests may be useful.

• Blood tests: dehydroepiandrosterone sulfate (DHEAS), testosterone, 17-hydroxyprogesterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin
• X-ray: bone age measurement

What is the treatment for infantile acne?

Treatment of infantile acne is usually with topical agents such as benzoyl peroxide or erythromycin gel.

In severe cases, oral antibiotics such as erythromycin and trimethoprim, or isotretinoin may be required.

NOTE: tetracycline antibiotics should not used in young children because they may cause yellow staining of the developing permanent teeth.

Baby acne causes

It’s not clear exactly what causes baby acne. Baby acne may be the result of maternal or infant hormones (androgens) stimulating glands in the baby’s face skin to produce oil, or sebum.

How does acne develop?

The sebaceous glands, located in the middle layer of skin, produce oil, or sebum, which normally travels to the skin’s surface via hair follicles. But when skin cells plug the follicles, blocking the oil coming from the sebaceous glands, skin bacteria (called Propionibacterium acnes, or P. acnes) begin to grow inside the follicles, causing inflammation.

Acne progresses in the following manner:

• Incomplete blockage of the hair follicle results in blackheads (a semisolid, black plug).
• Complete blockage of the hair follicle results in whiteheads (a semisolid, white plug).
• Infection and irritation cause whiteheads to form.

Eventually, the plugged follicle bursts, spilling oil, skin cells and the bacteria onto the skin surface. In turn, the skin becomes irritated, and pimples or lesions begin to develop. The basic acne lesion is called a comedo.

Acne can be superficial, producing pimples without abscesses, or deep, producing inflamed pimples that push down into the skin and cause pus-filled cysts that rupture and result in larger abscesses.

Baby acne prevention

Baby acne is common and temporary. There’s little you can do to prevent baby acne. Baby acne usually clears up on its own, without scarring.

Baby acne signs and symptoms

Baby acne consists of multiple red, raised pimples and pus-filled bumps, commonly found on the baby’s face, neck or trunk. Skin can have blackheads and whiteheads present as well. Pitting and scarring of the affected areas can occur in approximately 10–15% of affected infants.

Baby acne often develops within the first two to four weeks after birth.

Many babies also develop tiny white bumps on the nose, chin or cheeks. These are known as milia.

Baby acne diagnosis

Baby acne can usually be diagnosed on sight. No specific testing is needed.

Baby acne differential diagnosis

Pustular eruptions in a well-appearing baby:

• Miliaria rubra (also known as prickly heat) and miliaria pustulosa – identical to benign cephalic pustulosis but involves more of the skin folds (neck) and areas exposed to heat or occlusion
• Milia – More often on the nose and are white as opposed to erythematous
• Congenital candidiasis – More widespread and may be associated with infection of the mother, umbilical cord, or placenta
• Eosinophilic pustular folliculitis – More scalp involvement, rapidly crusts over, and is pruritic
• Staphylococcal folliculitis – More widespread and favors moist, occluded areas
• Scabies – Pruritic and more widespread
• Keratosis pilaris – Rough surfaced
• Nevus comedonicus – Unilateral and linear
• Erythema toxicum neonatorum – More widespread and transient

Note: Pustules in infants are usually innocuous and self-limited; however, several life-threatening conditions may present with vesicles or pustules. Therefore, accurate and prompt diagnosis is essential.

Pustular eruptions in a toxic-appearing baby:

• Neonatal herpes simplex virus (HSV)
• Bacterial sepsis
• Candidal sepsis
• Enteroviral infection

Baby acne treatment

Because baby acne typically disappears on its own within several months, no medical treatment is usually recommended. If your baby’s acne lingers for much longer, your baby’s doctor may recommend a medicated cream or other treatment. In mild cases, prescription therapy is generally unnecessary, and the lesions may resolve with gentle cleansing of the skin. The first-line treatment most physicians prescribe is 2.5% benzoyl peroxide. This is an gel that is applied to the skin; it is a commonly used acne product. It is generally well tolerated but may cause dryness. The next line of therapy, in severe cases, is to add an oral antibiotic. Most infants are able to stop oral antibiotics within 18 months. Rarely, cases of acne could be made worse by a fungus, which would require a topical antifungal applied to the skin for treatment. Your baby’s pediatrician may request the help of a pediatric dermatologist for severe cases of acne. Furthermore, in severe cases or those resistant to therapy, an investigation for an underlying hormonal (endocrine) disorder may be warranted.

These tips are useful for caring for your baby’s skin while he or she has acne:

• Keep your baby’s face clean. Wash your baby’s face daily with warm water and mild baby soap.
• Dry your baby’s face gently. Simply pat your baby’s skin dry.
• Don’t pinch or scrub the acne. You may cause more irritation or an infection.
• Avoid using lotions or oils on your baby’s face.

1. Infantile acne. https://dermnetnz.org/topics/infantile-acne