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Newborn Acne: Causes, Symptoms & Treatment

Newborn acne is a common, harmless skin rash that affects infants in the first weeks of life. Small pimples and pustules usually resolve on their own without treatment.

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Things worth knowing about "Newborn Acne"

Newborn acne is a common, harmless skin rash that affects infants in the first weeks of life. Small pimples and pustules usually resolve on their own without treatment.

What is Newborn Acne?

Newborn acne (medically known as acne neonatorum or neonatal acne) is a common, typically harmless skin condition that affects newborns during the first weeks of life. It appears as small red pimples, whitish pustules, or comedone-like lesions, predominantly on the face – especially on the cheeks, nose, and forehead. It is estimated to affect approximately 20 to 30 percent of all newborns. The condition is self-limiting, meaning it usually resolves without any medical treatment.

Causes

The exact causes of newborn acne are not yet fully understood. The main contributing factors include:

Maternal hormones: Androgens (male sex hormones) transferred from the mother during pregnancy can overstimulate the sebaceous glands of the newborn.
Overactive sebaceous glands: In the first weeks of life, the sebaceous glands of newborns are still very active, which can lead to clogged pores.
Yeast colonization: Overgrowth of the yeast Malassezia on the skin is also discussed as a possible contributing trigger.
Immature immune system: The not yet fully developed immune system of the newborn may contribute to skin irritation.

Symptoms

The typical symptoms of newborn acne include:

Small red papules (raised skin lesions) and whitish pustules
Predominantly on the cheeks, nose, forehead, and chin
Occasionally also on the scalp or back
No signs of pain or itching in the infant
No fever or general feeling of illness

Symptoms may temporarily worsen when the baby cries, is warm, or when saliva comes into contact with the skin.

Diagnosis

The diagnosis of newborn acne is typically made through a clinical examination by a pediatrician. Special laboratory tests or investigations are generally not necessary in typical cases. It is important to distinguish newborn acne from other skin conditions in newborns, such as:

Erythema toxicum neonatorum: Another common, harmless rash in newborns that has a different appearance.
Milia: Small white cysts caused by blocked sebaceous glands, without signs of inflammation.
Seborrheic dermatitis: A scaly, greasy rash that can also occur in infancy.

In unclear cases or when the condition is particularly severe, a referral to a dermatologist may be appropriate.

Treatment

In most cases, no specific treatment is required, as newborn acne resolves on its own – typically within a few weeks to months.

General Skincare Recommendations

Gently cleanse the infant's face daily with lukewarm water.
Avoid harsh cleansers, exfoliants, or creams unless recommended by a doctor.
Do not squeeze or rub the affected areas.
Use soft, skin-friendly clothing and bed linen.

Medical Treatment

In rare cases where the acne is very severe or persistent, a physician may consider a mild medical treatment. Options may include topical preparations containing ketoconazole (when fungal involvement is suspected) or, in exceptional cases, low-dose topical retinoids. These treatments must only be used under medical supervision.

When Should Parents See a Doctor?

Parents should seek medical advice if:

The skin lesions spread rapidly or appear severely inflamed.
The infant shows additional symptoms such as fever, restlessness, or sleep disturbances.
The acne does not improve after the third month of life or worsens over time.
Parents are unsure whether the condition is indeed newborn acne.

References

Eichenfield, L.F. et al. - Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology, 2016.
Nast, A. et al. - European evidence-based guidelines for the treatment of acne. Journal of the European Academy of Dermatology and Venereology, 2022.
World Health Organization (WHO) - Newborn care: skin care. WHO Guidelines, 2023.

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