Baby acne or neonatal acne can be present at birth or develop over the first 4 weeks of life. It usually appears as clogged pores or closed comedones and I occasionally pustules over the forehead, nose and cheeks.
There are lots of factors that can contribute to this developing. It is thought to be the result of maternal hormones and neonatal hormones that stimulate the oil glands on the face and increase oil production. Maternal hormones or androgens can transfer to the baby. Also, neonatal adrenal glands produce high levels of androgens called Dehydroepiandrosterone until about the age of 1 when the neonatal adrenal gland naturally shrinks. These hormones stimulate the sebaceous or oil glands resulting in increased oil production and the acne as a result of this. There are some studies that show that neonatal acne could also be a response to a yeast called malassezia but this is not seen in all cases. Does it represent a health risk? No; this is mild and self limited. It does not require treatment and spontaneously resolved usually by the age of 3 months with your scarring. However, if it is severe, persistent or doesn’t respond to topical treatment with anti acne medications, it is important to consider a workio for a condition called congenital adrenal hyperplasia, an underlying endocrine disorder, or a tumor that could be secreting excess hormones.
In routine cases, there is no scarring. It is superficial and not deep and cystic. However if there are severe and inflammatory lesions it is important to have these evaluated to intervene early with treatment and consider further workup if warranted.
That’s a good question- because it is hormonal it really cannot be prevented. Meaning this is not the result of something the parents are doing.
If interested in treating, traditional acne therapies do work. I tend to prefer azaleic acid cream - there is a 20% that is prescription and a 10% that is OTC. It’s not as drying or harsh as some of our other acne preps. Tretinoin cream can also be used but I tend to recommend using only 2-3 nights a week as it can cause a lot of dryness. If areas are inflamed or there are pustules you can also use either benzoyl peroxide gel (i would stick with a 1% or 2.5%) or a topical antibiotic called clindamycin.
Most often this self resolved and does not require treatment and does not scar unless severe. If parents do not wish to treat it, this is ok:) it does not require treatment in most cases. If it’s unclear if treatment should be tried it is a good idea to see your dermatologist to assess the risk of scarring.