What is the treatment for newborn acne?

Treatment of Newborn Acne

For most cases of newborn acne, no treatment is necessary as it typically resolves spontaneously without intervention. 1 When treatment is needed for more severe or persistent cases, gentle skin care with mild cleansers and water is the first-line approach.

Understanding Newborn Acne

Newborn acne (neonatal acne) is a transient dermatological condition that:

• Occurs in approximately 20% of newborns
• Typically appears between the second and fourth week of life
• Is more common in males (4.5:1 male-to-female ratio)
• Presents primarily as open and closed comedones that may evolve into papules, pustules, and rarely nodules
• Commonly affects the forehead, cheeks, chin, and eyelids, occasionally spreading to the scalp, neck, and trunk

The condition results from elevated production of placental and neonatal androgens which enlarge sebaceous glands and increase sebum production 1.

Treatment Algorithm

Step 1: Assess Severity

• Mild cases (most common): Observe only, as spontaneous resolution is expected
• Moderate cases: Consider gentle cleansing
• Severe or persistent cases: Consider medical intervention

Step 2: Basic Skin Care

• Use mild, pH-neutral cleansers specifically designed for infant skin 2
• Gently cleanse affected areas with warm water
• Pat dry (do not rub) the skin after cleansing
• Avoid harsh soaps, fragranced products, and oils that may exacerbate acne

Step 3: For Persistent or Severe Cases

For cases that don't respond to basic care:

1. For comedonal lesions:

   • Topical retinoids or 20% azelaic acid may be considered 1

2. For inflammatory lesions:

   • Topical antibiotics may be considered 1
   • If prescribed, erythromycin topical solution 2% can be applied to affected areas twice daily (morning and evening) after the skin is thoroughly washed 3

Important Considerations

Safety Precautions

• Avoid salicylic acid in infants under 2 years of age due to risk of salicylate toxicity 4
• Avoid benzoyl peroxide and combination products containing clindamycin or erythromycin with benzoyl peroxide, as safety has not been established in children under 12 years 4
• Avoid topical dapsone, as safety data only exists for children 12 years and older 4

Monitoring

• If using topical erythromycin:
  • Monitor for signs of local adverse reactions
  • Be aware that erythromycin can induce bacterial resistance when used as monotherapy 4
  • Discontinue if signs of irritation or sensitivity develop 3

When to Seek Further Evaluation

• If newborn acne is severe and long-lasting, clinical and laboratory evaluation may be necessary to rule out conditions such as:
  • Congenital adrenal hyperplasia
  • Virilizing tumors of adrenal or gonadal origin 1

Skin Barrier Protection

Maintaining the delicate skin barrier in newborns is crucial:

• Consider ceramide-containing moisturizers for dry areas, as they help maintain the protective skin barrier 5
• Minimize transepidermal water loss by avoiding excessive bathing 6
• Protect the skin from environmental irritants 2

Common Pitfalls to Avoid

• Overtreatment: Most cases resolve spontaneously without intervention
• Using adult acne products: Many adult acne treatments are too harsh for newborn skin
• Excessive washing: Can disrupt the skin barrier and worsen the condition
• Using fragranced products: Can irritate sensitive newborn skin

Remember that newborn skin is more permeable to topical agents and requires particular caution with skincare regimens 5. The primary goal is to maintain skin barrier function while allowing the condition to resolve naturally.