Pediatric Case Profiles and Their Approaches
Neonatal and infantile acne
Neonatal acne occurring at 0–8 weeks of life is estimated to affect 20% of newborns more frequently boys than girls.5 The condition usually presents small erythematous papules and pustules on the face, rarely with comedones.5,6,14 In the differential diagnosis, eruptions due to other causes need to be excluded, such as bacterial folliculitis, secondary syphilis, herpes simplex virus, and varicella-zoster virus.5,20,21 Other conditions to be ruled out comprise transient neonatal pustular melanosis, erythema toxicum neonatorum, eosinophilic pustular folliculitis, sebaceous gland hyperplasia, and congenital adrenal hyperplasia.21,22 Neonatal cephalic pustulosis due to colonization of Malassezia yeasts present monomorphic red papules or pustules on the face and neck without comedones.20,21 Maternal medications may also cause neonatal or infantile eruptions and should be checked; for instance, lithium, phenytoin, and corticosteroids. 21,22
While usually benign and self limited, rarely when neonatal acne presents with signs of sexual precocity, virilization, or growth abnormalities, significant neonatal acne may be due to an underlying endocrinologic disease, tumor, or other gonadal/ovarian pathology.5 These patients require a workup and a referral to a pediatric endocrinologist.5 Neonatal acne typically resolves over a few months without scarring.5 For more complicated cases, off-label topical therapies may be considered.5,14,21,22 Three neonatal and infantile acne patient case profiles and approaches are presented in Table 3.
Case 1 concerns neonatal acne in a 6-weeks-old female patient, addressing parental concerns and providing education on the condition. The condition is transient and well treatable. In the case of Malassezia sympodialis, treat the patient with topical ketoconazole and, if needed, hydrocortisone cream 1 to 2.5%. Further, consider benzoyl peroxide (BPO) or salicylic acid (SA) containing topical products and CERs-containing moisturizers.
