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Neonatal Acne (Baby Acne)

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What Is Neonatal Acne?
Neonatal acne, commonly called baby acne, is a common and harmless skin condition affecting approximately 20% of newborns. It typically appears during the first 2 to 4 weeks of life, although some infants are born with it. Despite its name, neonatal acne differs from adolescent acne and almost always resolves on its own without causing permanent scars.

Clinical Presentation
Neonatal acne most commonly presents with:

Small red papules (bumps)
Tiny pustules (“white pimples”)
Occasionally closed comedones (whiteheads)
Mild surrounding redness

Common locations

Cheeks (most common)
Nose
Forehead
Chin

Most infants are otherwise healthy and comfortable. Unlike eczema, babies generally are not itchy and appear completely well.

What Causes Neonatal Acne?
Although the exact cause is still being studied, several factors are believed to contribute.

Maternal hormones
Hormones transferred from the mother before birth temporarily stimulate the baby’s oil (sebaceous) glands.

Neonatal hormones
During the first few weeks of life, newborns naturally produce hormones that further activate sebaceous glands.

Increased sebum production
The enlarged oil glands may become temporarily clogged, producing acne-like bumps.

Yeast colonization
Some infants diagnosed with neonatal acne actually have neonatal cephalic pustulosis, which is associated with an inflammatory reaction to Malassezia yeast rather than true acne. This distinction may influence treatment in selected cases.

How Is Neonatal Acne Diagnosed?
Diagnosis is almost always clinical A board-certified dermatologist evaluates:

Age of onset
Appearance of the lesions
Distribution
Presence or absence of blackheads
Associated symptoms
Growth and overall health of the infant

No blood work or biopsies are typically necessary.

Treatment
Fortunately, neonatal acne usually does not require medication.

Recommended care

Wash the baby’s face gently once daily with lukewarm water.
Use fragrance-free cleansers only if recommended.
Avoid scrubbing.
Avoid oils or greasy lotions on the face.
Do not squeeze the bumps.

When medication may be considered
In unusual or persistent cases, a dermatologist may prescribe:

Topical ketoconazole (if neonatal cephalic pustulosis is suspected)
Mild topical acne medications in carefully selected patients
Additional evaluation if lesions persist or worsen

Parents should never apply over-the-counter acne products intended for teenagers or adults unless directed by a physician.

Prognosis
The outlook is excellent. Most cases:

Resolve within several weeks to a few months
Leave no scars
Do not predict severe acne later in life

When Should Parents See a Dermatologist?
Schedule an evaluation if:

Acne begins after 6 weeks of age
Large nodules or cysts develop
There is significant crusting or drainage
The baby appears ill or develops fever
The rash spreads rapidly
The diagnosis is uncertain

Frequently Asked Questions
Is neonatal acne contagious?
No.

Is it caused by poor hygiene?
No. Baby acne is not related to cleanliness.

Can breastfeeding cause baby acne?
There is no evidence that breastfeeding causes neonatal acne.

Will changing my baby’s formula help?
No. Formula changes are not recommended solely for neonatal acne.

Can breast milk cure baby acne?
There is no high-quality scientific evidence supporting topical breast milk as a treatment.

References

Krowchuk, Daniel P., et al. “Clinical Practice Guideline for the Management of Acne Vulgaris.” Pediatrics, vol. 154, no. 1, 2024, e2024068752. American Academy of Pediatrics. PMID: 38909715. https://pubmed.ncbi.nlm.nih.gov/38909715/

Hoeger, Peter H., and Amy S. Paller. Harper’s Textbook of Pediatric Dermatology. 5th ed., Wiley-Blackwell, 2020.

Eichenfield, Lawrence F., Ilona J. Frieden, and Nancy B. Esterly. Neonatal and Infant Dermatology. 4th ed., Elsevier, 2015.

Cunningham, Brian B., Amy S. Paller, and Lawrence F. Eichenfield. “Neonatal Dermatology.” In: Pediatric Dermatology. Elsevier, 2023.