What is the suggested treatment for newborn acne?

Treatment of Newborn Acne

Newborn acne (neonatal acne) typically requires no treatment beyond gentle cleansing with mild soap and water, as it resolves spontaneously in most cases. 1

Understanding Newborn Acne

• Neonatal acne is a transitory dermatosis occurring between the second and fourth weeks of life in approximately 20% of children, more commonly affecting males (4.5:1 male-to-female ratio) 1
• The condition results from elevated placental and neonatal androgens (adrenal origin in both sexes, testicular in males) causing sebaceous gland enlargement and increased sebum production 1
• Typical presentation includes open and closed comedones on the forehead, cheeks, chin, and eyelids, which may evolve into papules and erythematous pustules; nodules and cysts are rare 1

Treatment Approach by Severity

Mild Cases (Most Common)

• Use only a mild dermal cleanser with water for routine care 1
• Gentle cleansing is sufficient as resolution occurs spontaneously without intervention 1, 2
• Avoid harsh products or aggressive treatment, as neonatal skin is more permeable to topical agents and requires particular caution 3

Comedogenic Lesions (Open and Closed Comedones)

• Consider topical retinoids or 20% azelaic acid for persistent comedonal lesions 1
• These agents should only be used if lesions are bothersome and not resolving spontaneously 1

Inflammatory Lesions (Papules and Pustules)

• Topical antibiotics may be used for inflammatory lesions if treatment is deemed necessary 1
• However, most cases resolve without requiring antibiotic therapy 1

When to Investigate Further

• If neonatal acne is severe and long-lasting, perform clinical and paraclinical examination to exclude congenital adrenal hyperplasia or virilizing tumors of adrenal or gonadal origin 1
• Failure to resolve within 1 year warrants evaluation for androgen excess 2

Critical Differential Diagnoses

• Distinguish newborn acne from neonatal cephalic pustulosis (caused by hypersensitivity to Malassezia furfur, managed with topical ketoconazole in severe cases), other neonatal vesiculopustular dermatoses, infectious diseases, and acneiform reactions 1, 2

Common Pitfalls to Avoid

• Do not aggressively treat mild neonatal acne - the natural course is spontaneous resolution, and neonatal skin is particularly vulnerable to topical agents 1, 3
• Avoid using products containing sensitizing agents or fragrances on neonatal skin 3
• Do not confuse neonatal acne with infantile acne, which starts after the neonatal period and tends to be more pleomorphic and inflammatory, requiring more vigorous therapy 2, 4