Neonatal acne (baby acne): what it looks like, how long it lasts and when to see a GP

Neonatal acne is the name for acne-type spots that appear in the first weeks after birth. The Lewisham and Greenwich NHS Trust describes baby acne as a group of pimples that can develop on the baby's cheeks, nose and forehead within the first month and normally clear within a few weeks.

DermNet classifies acne in children by age. Neonatal acne covers birth to 6 weeks. Infantile acne covers 6 weeks to 1 year, and DermNet says it is rare, can occur in infants up to 16 months of age and occasionally leaves scarring. Acne in the 1 to 6 year age group is described as very rare and DermNet advises that an endocrinologist should be consulted to exclude excess androgen production in that age group.

DermNet says neonatal acne takes the form of comedones (whiteheads and blackheads) that can extend from the scalp, upper chest and back, together with inflammatory lesions such as red bumps and pustules on the cheeks, chin and forehead. NHS 111 Wales describes it as pimples on the cheeks and forehead, upper body and scalp.

A close look-alike is neonatal cephalic pustulosis. DermNet describes it as a variant of neonatal acne in which a pustular eruption arises on the face and/or scalp of newborn babies, often during the third week, and says that unlike true neonatal acne there are no comedones. DermNet adds that neonatal acne can be mistaken for it. For parents the practical point is that both are usually harmless and short-lived, and the distinction is mainly for clinicians.

DermNet says neonatal acne is thought to result from hyperactive sebaceous glands responding to the baby's own androgens and to maternal androgens that have crossed the placenta. Androgen levels wane after approximately a year, it says. It also reports that neonatal acne is more likely to affect boys than girls, at a ratio of 5 to 1.

None of the sources read for this page link neonatal acne to hygiene or to anything a parent has done; DermNet attributes it to hormones around the time of birth. Because the cause is hormonal and temporary, there is nothing in the sources read for this page to suggest that changing washing products, or changing a breastfeeding mother's diet, would prevent it.

NHS 111 Wales says you do not need to treat baby acne. The Lewisham and Greenwich page suggests that washing the baby's face with water and a mild moisturiser can improve the appearance of the skin, that the spots may occasionally get worse before they heal, and that acne medicines intended for older children and adults should be avoided.

• Wash the face with plain water and pat dry; keep any moisturiser mild.

• Do not squeeze, pick or scrub the spots.

• Do not use adult acne creams, washes or home remedies on a newborn.

• Ask your midwife, health visitor, pharmacist or GP if you are unsure what is safe.

NHS 111 Wales lists several common baby rashes. Tiny white spots on the nose (milia) usually go away within a few weeks and do not need treatment. Raised red, yellow and white spots (erythema toxicum) are common in the first few weeks, can disappear and reappear and should get better in a few weeks without treatment. Yellow, greasy, scaly patches on the scalp are likely to be cradle cap. Skin that is itchy, red, dry and cracked may be eczema, and a GP should be asked about that.

Because several of these look alike, a health visitor or GP can confirm which one it is, particularly if the rash is persistent, spreading or the baby seems uncomfortable.

The NHS rashes guidance says to call 999 or go to A&E if a child is unwell with a rash and has any of these: a stiff neck, bothered by light, confusion or agitation, difficulty breathing or very fast breathing, pale, blue, grey or blotchy skin, lips or tongue, sudden swelling of the lips, mouth, throat or tongue, a tight throat or trouble swallowing, or a rash that looks like small bruises or bleeding under the skin and does not fade when a glass is pressed against it.

It says to ask for an urgent GP appointment or get help from NHS 111 if you are worried about the rash and not sure what to do, if the baby feels hotter than usual or is sweaty or shivering, or if the baby is under 3 months old and has a temperature of 38C. A baby with acne-type spots who is otherwise well, feeding normally and has no fever is a different situation, but any new fever in a young baby should be checked promptly.

See a pharmacist or GP if spots appear for the first time after about three months, as the Lewisham and Greenwich page advises, or if they are not improving over the weeks and months described above.

NHS 111 Wales says baby acne usually gets better after a few weeks or months. DermNet says neonatal acne does not usually result in scarring. Infantile acne that starts later, according to DermNet, can occasionally leave scars and can rarely persist until puberty, though it says it is not associated with underlying endocrine abnormalities, which is why a clinician may want to look at a child whose spots are severe, long-lasting or unresponsive to treatment. A GP is the usual first step for that review, in the NHS or privately.