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Neonatal acne
Other Resources UpToDate PubMed

Neonatal acne

Contributors: Craig N. Burkhart MD, Dean Morrell MD, Lowell A. Goldsmith MD, MPH
Other Resources UpToDate PubMed

Synopsis

This summary discusses acne in neonates. Acne in infants and acne vulgaris in adults and children are addressed separately.

Neonatal acne, or neonatal cephalic pustulosis, is a very common acneiform eruption occurring on the face of neonates (ages 0-6 weeks). Many separate these two conditions as the following: neonatal cephalic pustulosis for a solely papulopustular eruption, often associated with Malassezia species, and neonatal acne for eruptions that include open comedones or nodulocystic lesions. This distinction is usually academic, as both tend to be very mild and spontaneously resolve by age 3-6 months without residual sequelae.

Codes

ICD10CM:
L70.4 – Infantile acne

SNOMEDCT:
49706007 – Infantile acne

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Pustular eruptions in a well-appearing neonate:
  • Miliaria rubra (also known as prickly heat) and Miliaria pustulosa – Identical to benign cephalic pustulosis but involves more of the skin folds (neck) and areas exposed to heat or occlusion.
  • Milia – More often on the nose and are white as opposed to erythematous.
  • Congenital candidiasis – More widespread and may be associated with infection of the mother, umbilical cord, or placenta.
  • Eosinophilic pustular folliculitis in infancy – More scalp involvement, rapidly crusts over, and is pruritic.
  • Staphylococcal Folliculitis – More widespread and favors moist, occluded areas.
  • Scabies – Pruritic and more widespread.
  • Keratosis pilaris – Rough surfaced.
  • Nevus comedonicus – Unilateral and linear.
  • Erythema toxicum neonatorum – More widespread and transient.
Note: Pustules in neonates are usually innocuous and self-limited; however, several life-threatening conditions may present with vesicles or pustules. Therefore, accurate and prompt diagnosis is essential.

Pustular eruptions in a toxic-appearing neonate:
  • Neonatal herpes simplex virus (HSV)
  • Neonatal bacterial sepsis
  • Disseminated candidiasis
  • Enteroviral infection

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated:01/06/2022
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Neonatal acne
A medical illustration showing key findings of Neonatal acne : Cheek, Erythema, Forehead, Pustule, Tiny papule
Clinical image of Neonatal acne - imageId=221053. Click to open in gallery.  caption: 'Multiple tiny pustules and papules and a few interspersed closed comedones, on a background of erythema on the central face.'
Multiple tiny pustules and papules and a few interspersed closed comedones, on a background of erythema on the central face.
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