What is neonatal acne?

Kathy Snider
Neonatal Nursing

Neonatal acne, or baby acne, is a very common concern for new parents. It can be present at birth, but more often it shows up after a couple of weeks after birth and usually can be found on the baby’s cheeks, and sometimes on their forehead, chin, and even their back.

Newborn rash, or erythema toxicum, varies somewhat from neonatal acne, and can also found at birth and up to the first three weeks of age. The rash is believed to be a response to living outside of the womb, and does not require and treatment.

These small whiteheads might be surrounded by reddish skin. They can become more pronounced when your baby is hot or fussy or if his skin is irritated by saliva, spit-up milk, or fabric that's a little rough or that's been washed in strong detergent.

Many parents wonder what causes neonatal acne, but the experts even don’t fully know… For some time, experts have pointed to the hormones babies receive from their mother at the end of pregnancy as a cause of baby acne. But researchers continue to study other factors and have yet to agree on one culprit. If you take certain medications while nursing, for example, or if your baby takes certain medications, those medications might trigger baby acne. Other parents and experts have reported that certain soaps, detergents and lotions seem to trigger it. For any concerns regarding the health of your new baby, be sure to seek out your health care provider for additional answers.

Mary Wessinger
Neonatal Nursing

This newborn condition is not neonatal acne, it is called Erythemia Toxicum, often called "newborn baby rash."  These are lesions surrounding the hair follicles, which are firm, and can vary in size, from 1 to 3 mm. This may be a white or pale yellow pustule. the peak incidence for this is from 24 to 48 hours after birth. This may appear on the trunk, cheeks, and may be widespread over the infant's skin. It does not appear on the palms or the soles of the feet. It is self-limiting and nothing should be done. The cause is unknown. This is rarely present at birth and does not appear after 5 days. Do not put cream or any type of lotion on this. When a smear is aspirated on the papule, does not show bacteria, only numerous esinophils. this is a normal variation of newborn skin. (London, et al. 3rd edition of Maternal and Child Nursing Care). I have seen this many times in my practice, all new parents need to be assured this is a normal variation and it will clear up in a few days.

Ms. Kathryne A. LeMieux
Neonatal-Perinatal Medicine

There is a great answer to this question from Dr. Doris Day in this thread. Remember not to attempt to pop or drain the small pustules associated with neonatal acne. They are not blackheads and a common, normal variation found on newborn skin. Your child was in an fluid-filled environment prior to birth and their skin has numerous mechanisms for adapting to life outside of your uterus. Squeezing or popping skin eruptions on newborns may worsen the condition and lead to infections, scarring, and pain for your new precious baby. If you are really concerned, see your pediatrician or primary provider, and let the experts help you. There may be some creams or lotions that can reduce this inflammation or treat worsening symptoms.

Dr. Doris Day, MD
Acne in newborns (neonatal acne) is one of the more common eruptions, occurring in approximately 20% of newborns. It typically appears at approximately 2 to 3 weeks of life and looks like small, red bumps and pustules that are scattered over the cheeks of the newborn child. The forehead, eyelids, chin, neck, and upper chest may also become involved.

Acne or acne-like breakouts in newborns can be difficult to diagnose accurately because there are different, usually temporary and harmless conditions of the skin that often look very similar but have different underlying causes. Several temporary and harmless hormonal imbalances can occur in the neonatal period that may play a role in the newborn period; however, comedones, which are the typical lesion seen on adolescent acne, are not seen in acne of the newborn. There can also be involvement of a yeast called Pityrosporum rather than Propionibacterium acnes or the conditions that normally cause acne. This type of rash is not harmful to the child and can be treated with a topical antifungal that the baby’s doctor prescribes.
100 Questions & Answers About Acne

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.