Neonatal Cephalic Pustulosis (Neonatal Acne)

Neonatal acne is now referred to as neonatal cephalic pustulosis to distinguish it from infantile and adolescent acne.
Neonatal cephalic pustulosis is a benign self-limiting condition that is estimated to occur in 25% of neonates.

Recent data suggest the papules and pustules in this condition may be the result of an inflammatory response to Malassezia spp.
Increased rates of sebum secretion during the neonatal period are also thought to play a role.

Presents at 2 to 3 weeks of age as discrete erythematous papules and pustules on the cheeks, or, less often, on the forehead, chin, scalp, and chest (Figs. 3.1 and 3.2).
Unlike infantile and adolescent acne there are no comedones and the course is self-limiting.
Eruption is asymptomatic.
Resolves spontaneously in weeks to months.

Diagnosis is usually made clinically.
A Giemsa stain may show yeast forms, neutrophils, and other inflammatory cells.
When in doubt a Gram stain can rule out bacterial folliculitis and a KOH can rule out candidiasis.

Differential Diagnosis

Miliaria Rubra

Lesions can be indistinguishable from neonatal cephalic pustulosis, but will be located in body folds and areas subject to heat and occlusion.

Erythema Toxicum Neonatorum

Lesions are more widespread and scattered in distribution over trunk and face.
Lesions often associated with a pink edematous wheal.

Candidiasis

Management

No treatment is required as the condition self-resolves by 3 to 6 months of age.
Parents should be instructed to gently wash the newborn's face twice daily with a mild soap and water.
In severe cases, the application of topical imidazoles such as ketoconazole 2% cream or econazole 1% cream twice daily can lead to improvement.
Topical hydrocortisone 1% cream can be helpful if lesions are very red.
Application of oils or ointments may exacerbate condition.

Helpful Hint