Neonatal and infantile acne - does it require treatment?

Neonatal and infantile acne - does it require treatment?

Neonatal acne is usually mild and does not require treatment since its symptoms resolve on their own. However, it should be approached with care. The situation is similar when it comes to acne occurring in infants. Only very severe infantile acne may actually require treatment. 

A newborn's skin is extremely delicate and often requires special care. It is characterized by an extremely thin stratum corneum and a poorly developed granular layer. In addition, a newborn's sweat and sebaceous glands are not fully developed. Physiological changes, exposure to sunlight, or normal fluctuations in ambient temperature can cause a number of changes in the baby's skin, including neonatal and infantile acne. 

Acne is characterized according to the age at which it occurs: 

neonatal acne: first 6 weeks after birth

infantile acne: from 6 weeks to 12 months old,

mid-childhood acne: from 1 to 6 years old,

prepubertal acne: from 7 to 12 years old (or until the first menstruation in girls),

juvenile acne: from 12 to 19 years old. 

Neonatal acne – what is it characterized by? 

Neonatal acne may occur in the first 4-6 weeks of the child's life and, according to statistics, it affects up to 20% of all newborns. Skin lesions in the form of small lumps appear on the baby's forehead, cheeks, and nose. Such symptoms are usually accompanied by an overgrowth of the sebaceous glands. 

The cause of neonatal acne is not yet fully understood. Its appearance on the skin of a baby is most likely related to hormonal imbalances caused by maternal androgen hormones, transmitted with breastmilk, or even in the prenatal period. The second likely cause is the excess production of a hormone called dehydroepiandrosterone (DHEA) by the baby's adrenal cortex.  

As a result of hormonal changes, the enlarged sebaceous glands in the newborn's skin produce excessive amounts of sebum, which in turn results in the appearance of pimples.  

Fortunately, the course of neonatal acne is usually mild and requires no treatment, only proper care. Symptoms should resolve on their own, but it is worth consulting a pediatrician to rule out viral, bacterial, and fungal infections, or diseases such as pustular melanosis or toxic neonatal erythema.

Infantile acne

Infantile acne – symptoms 

Infantile acne can be significantly more severe than neonatal acne. Its main symptoms include papules, pustules, and cysts. Infantile acne usually appears on the face - especially the cheeks. Occurring exanthems can cause scarring, which is why a quick medical consultation and immediate introduction of appropriate treatment is so important. 

Infantile acne is usually caused by a disturbance in the endogenous secretion of androgens, such as DHEA, by the child’s adrenal cortex.

It is worth stressing that infantile acne occurs mainly in boys. This is due to the increased secretion of LH (luteinizing hormone, lutropin), which in turn stimulates androgen synthesis in the testes. Acne is probably a result of the immaturity of the hormonal feedback loop between the gonads and the pituitary gland. 

Propionibacterium acnes is also involved in the etiopathogenesis of infantile acne. These anaerobic, gram-positive bacteria colonize seborrheic areas of the skin. The increased production of sebum during the occurrence of acne in children accelerates the multiplication of Propionibacterium acnes in the lesions. As a result, exanthems worsen, and additionally, the proliferation of keratinocytes and the synthesis of pro-inflammatory factors, including interleukin-8 (IL-8), are stimulated.

Infantile acne – treatment 

In most cases infantile acne is mild and resolves without interference, so only severe lesions may require pharmacotherapy. The problem, however, exists in the lack of registered medications suited for children under 12 years of age, so treating infantile acne can be a bit problematic and requires an individual approach to each patient.

In extremely severe cases, treatment may consist of topically applying preparations containing benzoyl peroxide or retinoids. Sometimes antibiotic therapy proves necessary, and so erythromycin, amoxicillin, cephalexin, and azithromycin may be administered. It is worth knowing that in the youngest patients, tetracyclines must not be used, as they interfere with tooth development.

When very severe symptoms are observed, it may be necessary to use orally applied isotretinoin, which is a synthetic derivative of vitamin A. This drug reduces the activity of the sebaceous glands and inhibits their excessive growth, thus reducing the appearance of exanthemas.

Remember that it is your doctor who should decide what type of treatment to apply.

It should be noted that in children aged 1 to 7, acne occurs very rarely. If the skin lesions are accompanied by other disturbing symptoms, such as premature puberty, you should seek medical advice.

Infantile acne and protein intolerance 

The appearance of pimples on a child's face is usually seen as a symptom of protein intolerance, i.e. an allergy to proteins contained in cow's milk. However, infantile acne and dairy hypersensitivity are two different medical conditions. 

In the case of an allergy to cow's milk proteins, skin changes occur not only on the face, but also on the abdomen, arms, thighs, and underneath elbows and knees. In addition, bloating, abdominal pain, and loose, frothy stools, often with blood streaks can all be symptoms of this type of allergy. Symptoms recede after the introduction of an elimination diet and proper lubrication of the dry skin of your little allergy sufferer. 

On the other hand, in the case of infantile acne, fatty ointments should not be used, and the symptoms simply disappear on their own. Acne is most often the result of hormonal changes, so dieting is not justified in this case. The correct course of action should be determined by a pediatrician.

Acne and skincare in infants 

An infant's skin requires special treatment. For washing, use dermocosmetics, preferably those recommended by the Institute of Mother and Child. Choose preparations with neutral pH levels and no fatty substances that could clog pores and aggravate acne lesions. After washing the child's skin, dry it thoroughly, but gently.   

The choice of washing agent is also important. Toddlers' clothes should be washed only in delicate, hypoallergenic liquids or powders. 

Remember that acne is usually harmless for toddlers and goes away quickly. However, if you notice an increase in skin lesions and the presence of other symptoms, such as premature puberty, you should visit a specialist.