Neonatal acne

What is neonatal acne

It is a form of acne that develops during childhood and occurs on the face, especially on the cheeks, nose, forehead and chin.

It is one of the most common disorders of the neonatal age and, in most cases, is temporary.

Acne, both neonatal acne and forms that develop later, is caused by inflammation of the skin, which mainly affects the hair follicles. These are structures similar to a blind-bottomed canal, lined with cells called keratinocytes. Follicles are present not only on the skin of the face, but also throughout the body, including the back, shoulders, arms and scalp.

Inside them are the sebaceous glands that produce sebum, a substance consisting mainly of fat. Under normal conditions, through the pores this material reaches the surface of the skin, with the purpose of lubricating it; In fact, sebum participates in the formation of the so-called cutaneous hydrolipidic film, a thin protective layer, which keeps the epidermis hydrated.

In some cases, however, two circumstances can occur, which can cause inflammation of the skin, rash and the appearance of typical pimples:

• excessive secretion of sebum by the sebaceous glands
• the desquamation of the duct due to the excessive proliferation of keratinocytes that line it.

When these two events occur simultaneously, obstruction of the follicular canal may occur, which in turn favors the proliferation of bacteria normally present on the skin and which are usually harmless, especially Propionibacterium acnes.

There are several degrees of acne:

• Grade 1 (mild acne): presence of pimples and blackheads with few papules containing pus
• Grade 2 (moderate): presence of papules and pustules in particular in the facial area
• Grade 3 (moderately severe): high presence of papules and pustules and some nodules not only at the level of the face, but also of the back and chest
• Grade 4 (severe): presence of a large and painful number of large and painful subcutaneous papules, pustules and nodules.

Symptoms of neonatal acne

Acne that affects in the first months of life is manifested by the appearance on the baby’s skin of lesions such as:

• papules, skin lesions that appear as small pinkish growths, which can sometimes cause pain or itching
• Pustules, similar to papules, characterized by a white tip that contains pus.

All these phenomena can occur simultaneously in the same child and are associated with the appearance of milia, white dots that can appear on the nose, chin and cheeks.

Contrary to acne that occurs in other periods of life, neonatal acne does not include comedones, also called whiteheads (closed comedones) and blackheads (open comedones). Also rare is the formation of nodules or cysts, which can cause the appearance of more or less deep scars.

Causes of neonatal acne

The cause of this pediatric disorder is still unclear. There are several theories that acne could be provoked by:

• family predisposition, as it is believed that childhood acne can be influenced by genetic factors (the chances of being affected by acne are greater if one of the two parents in the family has suffered from it and increase considerably if both have been affected by this disorder)
• excessive activity of the sebaceous glands in response to normal hormone production of androgens (in both boys and girls)
• certain external agents, medications (such as steroids) or irritants present in creams and lotions.

Another hypothesis is that acne in the newborn is caused by the mother’s hormones, which pass to the child through the placenta and umbilical cord.

Even if at birth the connection between mother and baby is interrupted, maternal hormones (especially estrogen) remain in the baby’s body for the first few weeks of life and must be disposed of by the baby’s liver. The presence of these excess substances in the blood could cause the appearance of lesions typical of neonatal acne.

Myths to debunk

If a single and definitive explanation does not yet exist, however, “hoaxes” abound. Below we reveal some of them, which concern all forms of acne, not just neonatal acne:

• Acne is caused by poor diet: false, because there is no close correlation between the intake of a specific food and the appearance of lesions. This also applies to newborns: acne does not depend on the type of milk in formula, nor on the mother’s diet if the baby feeds on breast milk
• Acne is caused by poor skin hygiene: false because it is not the lack of cleanliness that causes the typical rash of this disorder
• Squeezing blackheads and pimples is a good method to eliminate them: false since this practice, if performed independently at home, can worsen the manifestations and could even leave scars on the skin.

Diagnosis of neonatal acne

The diagnosis of neonatal acne can be made by the doctor with a simple physical examination of the skin of the newborn, observing the areas affected by the appearance of the lesions, in particular, face, chest and back.

It is important to come to a diagnosis of neonatal acne, especially to distinguish it from other diseases, including:

• periorifitial dermatitis
• Keratosis pilaris
• Infections
• Atopic dermatitis
• dermatosis
• eczema
• erythema
• exanthematous diseases
• allergies.

These are in fact common disorders in babies, even in periods such as breastfeeding or weaning, which can be characterized by the presence of spots or patches, which in some cases could be confused with the typical lesions of acne.

Phenomena of redness and skin rash, sometimes mistaken for childhood acne, can occur even after vaccinations.

Remedies for neonatal acne

In most cases, acne is a phenomenon that runs out spontaneously within a few months of the appearance of the first symptoms. However, if it is particularly serious or annoying, or lasts a very long time, the pediatrician may decide to prescribe appropriate therapy.

You can use an ointment or cleanser specially designed for acne in the newborn, which can be applied topically to the lesions. If acne is associated with a bacterial infection, the pediatrician may prescribe an antibiotic.

The key recommendation? Avoid DIY and never buy products without the advice of the pediatrician. The skin of the newborn is in fact particularly delicate.

Prevention of neonatal acne

For the prevention of neonatal acne, but also to avoid its worsening, it may be useful to follow some simple hygiene rules:

• wash your hands thoroughly often to reduce the risk of infection, and avoid touching your baby’s face too much (or try to prevent them from touching too much)
• Do not wash acne-affected areas of skin more than twice a day
• During the bath, use warm water and mild soaps specially formulated for newborns, so as not to worsen skin irritation
• Do not rub the skin of the face to dry it, but use a soft and light towel (preferably cotton) to gently dab the face
• Avoid squeezing pimples.