Neonatal acne is a term that describes acneiform changes in the neonate. Onset is in the first few weeks of life. This condition usually remits after 6-8 weeks. Classic teaching states that maternal hormones increase the infant's sebum production causing comedones and acne. However, some infants with what appeared to be neonatal acne were found to have Malassezia furfur by direct microscopy of pustular material. Ketoconazole 2% cream BID clears this eruption within one week. Thus, there may be two key etiologic factors here.
Typically, the newborn develops small comedones and erythematous papules on the cheeks.
In the neonatal cephalic pustulosis variant, onset is often 3-4 weeks of age and more widespread on the face, scalp, and neck.
For neonatal acne, treatment is usually not necessary as the condition spontaneously remits. If desired or the condition is moderate to severe, topical erythromycin, clindamycin or 2.5% benzoyl peroxide may be given as one would for acne. As noted above, if M. furfur is suspected, ketoconazole 2% cream BID may be prescribed.
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