From the Guidelines
Neonatal acne typically requires no treatment as it is a self-limiting condition that resolves spontaneously within a few weeks to months. Parents should be advised to gently cleanse the affected areas with water and mild soap, avoiding harsh scrubbing or over-washing which can irritate the baby's sensitive skin. No topical medications are routinely recommended for mild cases. For more persistent or severe neonatal acne, a pediatrician may recommend 2.5% benzoyl peroxide lotion applied sparingly once daily, though this is rarely necessary, as supported by the guidelines of care for the management of acne vulgaris 1. In extremely severe cases that don't respond to conservative management, a dermatology referral may be considered for possible prescription of a mild topical retinoid or 2% ketoconazole cream. The condition occurs due to maternal hormones that cross the placenta and stimulate the baby's sebaceous glands, causing temporary inflammation and comedones. Parents should be reassured that neonatal acne does not cause scarring and has no long-term health implications for their baby.
Some key points to consider in the management of neonatal acne include:
- Gentle skin care to avoid irritation
- Avoidance of topical medications unless absolutely necessary
- Consideration of 2.5% benzoyl peroxide lotion for more persistent cases
- Potential referral to a dermatologist for severe cases
- Reassurance regarding the self-limiting nature and lack of long-term implications of neonatal acne, as there is no direct evidence-based recommendation for neonatal acne treatment in the provided guidelines 1.
It's essential to prioritize the baby's comfort and skin health, and to manage expectations regarding the condition's resolution and potential treatments, based on the most recent and highest quality studies available 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION: Erythromycin Topical Solution should be applied over the affected areas twice a day (morning and evening) after the skin is thoroughly washed with warm water and soap and patted dry. Acne lesions on the face, neck, shoulder, chest, and back may be treated in this manner. The recommended treatment for neonatal acne is not explicitly mentioned in the provided drug label. However, for acne lesions, the label recommends applying Erythromycin Topical Solution twice a day.
- Key points:
- Apply the solution after washing the skin with warm water and soap
- Pat the skin dry before application
- Apply with an applicator top or washed fingertips
- Reduce application frequency if drying and peeling occur 2
From the Research
Treatment of Neonatal Acne
The recommended treatment for neonatal acne is primarily focused on mild and gentle care, as most cases are transient and resolve spontaneously.
- For mild cases, the use of a mild dermal cleanser and water is often sufficient 3.
- For comedogenic lesions, such as open and closed comedones, topical retinoids or 20% azelaic acid may be used 3.
- In cases of inflammatory lesions, some topical antibiotics may be applied 3.
Considerations for Infantile Acne
In cases where the acne persists beyond the neonatal period into infancy, the treatment approach may need to be adjusted.
- Topical treatments such as benzoyl peroxide, erythromycin, and retinoids can be effective for mild infantile acne 4.
- For moderate to severe cases, oral erythromycin may be necessary, with the possibility of requiring long-term treatment 4.
- In rare and severe cases, oral isotretinoin may be considered, especially if there is resistance to other treatments or significant scarring 4, 5.
General Principles
It's essential to differentiate neonatal and infantile acne from other skin conditions that may present similarly in this age group.
- The diagnosis of neonatal acne is clinical, with main differential diagnoses including neonatal cephalic pustulosis, other neonatal vesiculopustular dermatoses, infectious diseases, and acneiform reactions 3.
- Treatment should be tailored to the severity and type of acne lesions, with a focus on minimizing the risk of long-term sequelae such as scarring 4, 6, 7.