What is the treatment for baby acne?

Treatment for Baby Acne

For baby acne (neonatal and infantile acne), gentle skin care with warm water and soap is the primary approach, with low-concentration benzoyl peroxide (2.5%) reserved for inflammatory lesions when treatment is necessary, though most topical acne medications lack established safety data in children under 12 years of age. 1, 2

Initial Management Approach

• Most baby acne is self-limited and requires only gentle cleansing with warm water and soap, followed by patting the skin dry. 3
• The affected areas (typically face, neck, and occasionally chest and back) should be washed twice daily without aggressive scrubbing to avoid irritation. 4, 3

When Topical Treatment Is Considered Necessary

For Inflammatory Lesions

• Benzoyl peroxide 2.5% is the American Academy of Dermatology's recommended first-line topical treatment for inflammatory baby acne lesions, though it must be used with caution due to potential skin irritation. 1, 2
• Apply as a thin film once daily after washing, using only a pea-sized amount for each facial area (forehead, chin, each cheek). 2
• Start with the lowest concentration (2.5%) and monitor closely for erythema, scaling, dryness, or excessive peeling. 5, 2

For Comedonal Lesions

• Azelaic acid 20% may be considered for comedogenic lesions with a more favorable safety profile (pregnancy category B), though safety and effectiveness have not been formally established in children under 12 years. 1, 2

Critical Safety Considerations and Contraindications

• The American Academy of Dermatology explicitly advises against using adult acne medications in children under 12 years, as safety and effectiveness have not been established for most topical agents in this age group. 1, 2
• Salicylic acid preparations are not recommended in children under 2 years of age due to increased risk of salicylate toxicity. 5
• Topical retinoids (except adapalene, which is approved for ages 9 and older) are not FDA-approved for children under 12 years. 2
• Topical antibiotics should not be used as monotherapy due to antibiotic resistance concerns; if needed, they must be combined with benzoyl peroxide. 2

Managing Side Effects

• If dryness or peeling occurs with benzoyl peroxide, reduce application frequency to every other day or discontinue temporarily. 5, 2
• Common adverse effects include erythema, scaling, stinging, and burning—all warrant dose reduction or treatment cessation. 5, 2
• Minimize exposure to sunlight and weather extremes to reduce irritation risk. 2

When to Escalate Care

• If baby acne is severe, highly inflammatory, or associated with signs of virilization (in infantile acne), evaluation for underlying endocrinologic abnormalities is warranted, as this may indicate androgen excess or other hormonal disorders. 6, 7
• Infantile acne (presenting after 6 weeks of age) tends to be more pleomorphic and inflammatory than neonatal acne, often requiring more aggressive therapy and dermatology referral. 6
• Refer to pediatric dermatology if there is no improvement after 8-12 weeks of appropriate treatment, evidence of scarring, or significant psychological impact on the family. 2, 3

Common Pitfalls to Avoid

• Do not use multiple topical medications simultaneously without guidance, as this compounds irritation risk. 5, 8
• Avoid tetracycline antibiotics (doxycycline, minocycline) in any child under 8 years due to permanent tooth discoloration risk. 2
• Do not assume all acne in infants is benign—infantile acne presenting with significant virilization may herald later severe adolescent acne or indicate underlying endocrine pathology. 6