Treating Baby Acne and Blackheads

mother rubbing cream on a baby's cheek

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You may associate acne with adolescence, but up to 20 percent of newborns also develop the condition. Baby acne (aka neonatal acne) usually occurs when an infant is a few weeks old and is probably triggered by exposure to maternal hormones during pregnancy, as well as the result of elevated infant androgens (male hormones). The hormones stimulate the baby's oil glands and typically cause whiteheads and pink pimples on the cheeks, nose, and forehead, though breakouts can also appear on the chin, scalp, neck, back, or chest.

Possibly due to the involvement of male hormones (though females also have them), neonatal acne tends to be more common in boys.

Treatment

Newborn acne is generally nothing to worry about: It doesn't harm your baby in the least and is purely a cosmetic issue. It rarely causes scarring and almost never needs to be treated. The vast majority of cases will go away on their own after one to three months when the size of the baby's oil glands and the amount of oil production decreases.

In the meantime, gently cleanse your baby's delicate skin with lukewarm water alone (not hot) or with a mild soap. Avoid vigorous washing, scrubbing, and using moisturizers and other oily or greasy creams and lotions, which can exacerbate the problem. Since the acne looks worse than it makes your baby feel, it's usually best to just leave it alone and understand that it will eventually go away.

Though rarely necessary, breakouts can be treated with topical retinoids (to help keep pores clear), benzoyl peroxide or erythromycin (antibacterial agents), and azelaic acid cream (an anti-inflammatory). However, you should always talk to your pediatrician before applying any treatment to your baby's skin.

When Older Infants Develop Acne

Less commonly, babies can start breaking out at around 3 to 6 months of age. This is known as infantile acne. Like neonatal acne, infantile acne also generally affects the face and occurs more commonly in boys. However, this type of acne tends to be more severe and carries a risk of scarring. As a result, long-term treatment with topical retinoids and antibacterials may be required and testing for elevated levels of hormones should be considered. Most cases of infantile acne resolve by age 4 or 5, but some remain active into puberty. Babies with a history of infantile acne have an increased incidence of teenage acne.

Conditions That Look Like Baby Acne

Other common skin conditions that newborns and younger infants develop that can be confused with baby acne include:

  • Erythema toxicum neonatorum: Up to 70 percent of newborns develop these pustules that are surrounded by a blotchy red area. The bite-like bumps usually appear during when babies are two or three days old (the cause is unknown) and go away after about a week without treatment, though they may reoccur for several weeks.
  • Heat rash: Also known as miliaria or prickly heat, heat rash results when sweat glands become blocked and perspiration gets trapped beneath the skin. It affects up to 40 percent of infants and occurs most commonly in hot, humid weather. Heat rash, which looks like clusters of tiny bumps surrounded by red skin, usually resolves when the skin is allowed to cool off.
  • Milia: Half of newborns experience these tiny pearly white or yellow bumps that are caused by an overgrowth of protein in the skin. They usually disappear on their own after a month.
  • Infantile seborrheic dermatitis: Many parents know this extremely common rash as "cradle cap" because it occurs most commonly on the scalp, though other affected areas may include behind the ears, in the creases of their neck, arms, and legs, and the diaper area. Like baby acne, infantile seborrheic dermatitis often goes away on its own in a few weeks or months.
  • Eczema: A red, inflamed, itchy rash that may be scaly, crusty, or oozy, eczema is an inherited form of skin sensitivity that causes extremely dry skin. It usually shows up around the three-month mark as dryness on the cheeks, but it may move to other parts of the body. Luckily, eczema tends to improve as babies get older and skin becomes less sensitive.
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