Neonatal acne

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Neonatal acne
Other namesAcne infantum, acne neonatorum, [1] and neonatal cephalic pustulosis [2]
Neonatal acne on the forehead of an infant, 2009-10-18.jpg
An infant with neonatal acne on the face, especially the forehead
Specialty Dermatology

Neonatal acne, also known as acne neonatorum, is a type of acne that develops in newborns, typically before six weeks of life. [3] It presents with open and closed comedones on the cheeks, chin and forehead. [4]

Contents

The main cause is not known for certain but it may be caused by maternal androgens transferred from the mother to the newborn from the placenta and androgens produced by the fetal adrenal gland and neonatal testicles that stimulate sebaceous glands to increase production of sebum. [4] [5] As a self-limiting condition, neonatal acne tends to resolve on its own but treatment options can include topical benzoyl peroxide, topical retinoids, topical antibiotics and topical antifungals. [6] [7]

Signs and Symptoms

Neonatal acne presents from birth to within the first 4-6 weeks of life. [8] [5] Common symptoms are open and closed comedones such as papules and pustules that occur most commonly on the face on the areas of the cheeks, chin and forehead. [4] Less commonly, lesions can be present on the chest and back. [7]

Causes

It is believed that maternal androgens passed to the infant through the placenta has a role in stimulating sebaceous glands leading to increased sebum production that causes comedone formation. [4] [5] Dehydroepiandrosterone (DHEA) produced from the fetal adrenal gland and androgen production from neonatal testicles may also stimulate sebum production from sebaceous glands. [7] [5]

The role of genetics is unclear but a positive family history supports association with neonatal acne. [8]

Some researchers suggest the role of Malassezia colonization causing hypersensitivity reactions in skin but this tends to be linked to neonatal cephalic pustulosis more so than neonatal acne. [4]

Diagnosis

A work up is suggested in cases of severe acneiform eruptions or with signs of growth abnormalities to rule out potential endocrine diseases, tumor formation, or gonadal development abnormalities. A referral to a pediatric endocrinologist may be warranted. [9]

Differential Diagnosis

Other causes of acneiform eruptions such as those induced by the use of topical products like creams, ointments and shampoos on the skin are often ruled out before diagnosis. [7] Maternal medications like lithium and high dose corticosteroids may also induce formulation of pustules in newborns and can be assessed with a thorough family history. [8] Likewise, newborns can be assessed for infection whether bacterial, fungal or viral in nature. Erythema toxicum neonatorum, neonatal cephalic pustulosis, transient neonatal pustular melanosis, folliculitis, miliaria and milia are often ruled out before diagnosis. [4] [7]

Some experts consider neonatal cephalic pustulosis (NCP) a form of neonatal acne while others do not. [5] NCP presents with facial papules and pustules but no comedones. NCP has been linked to Malassezia colonization, a normal yeast found on skin, but inconsistent patterns of positive colonization and NCP suggests that Malassezia hypersensitivity reactions in susceptible newborns are the cause of the acneiform eruptions rather than colonization itself. [5] [8]

Treatment

Neonatal acne will typically resolve by itself in 2-6 months. In mild cases, cleansing the face daily with gentle soap and water while avoiding use of potential comedogenic soaps, lotions and oils is often enough. Further treatment is not necessary but in severe or persistent cases topical therapy can be initiated. [7]

Benzoyl Peroxide

Topical benzoyl peroxide (BPO) may be indicated in persistent or inflammatory cases. [7] BPO is a lipophilic agent that penetrates into sebaceous glands and generates reactive oxygen species that kill P. acnes. [6] It also has comedolytic and anti-inflammatory properties and can prevent development of antimicrobial resistance. [10]

Topical Retinoids

Topical retinoids can be used alone or in combination with BPO. Retinoids are derived from vitamin A. They bind to retinoic receptors to normalize the rate of keratinocyte growth and prevent inflammation. [11] [12] Overactive keratinocyte production can lead to comedone formation. [13]

Topical Antibiotics

In cases where scarring is a concern, topical antibiotics may be recommended. [6] Topical clindamycin and erythromycin are the most commonly prescribed options for acne. Antibiotics kill P. acnes on skin that could be causing inflammation. [13] With the emergence of resistant P. acnes, experts recommend topical antibiotics to be used in combination with BPO to reduce the risk of development of antimicrobial resistance. [6] The most common side effects of topical antibiotics are stinging, burning and redness at the site of application. [5]

Topical antifungals

Some experts suggest the use of topical ketoconazole in newborns with more pustular neonatal acne as there is evidence it shortens duration of lesions. [5] This may be in cases more suggestive of neonatal cephalic pustulosis than neonatal acne. [7]

Epidemiology

20% of newborns will develop neonatal acne however there has been debate if this is an accurate representation of actual diagnosed cases of acne as this could include other acneiform eruptions that do not present with comedones like neonatal cephalic pustulosis. [12] Neonatal acne occurs more often in boys than in girls. [4]

See also

Related Research Articles

<span class="mw-page-title-main">Acne</span> Skin condition characterized by pimples

Acne also known as acne vulgaris, is a long-term skin condition that occurs when dead skin cells and oil from the skin clog hair follicles. Typical features of the condition include blackheads or whiteheads, pimples, oily skin, and possible scarring. It primarily affects skin with a relatively high number of oil glands, including the face, upper part of the chest, and back. The resulting appearance can lead to lack of confidence, anxiety, reduced self-esteem, and, in extreme cases, depression or thoughts of suicide.

<span class="mw-page-title-main">Dandruff</span> Skin condition of the scalp

Dandruff is a skin condition that mainly affects the scalp. Symptoms include flaking and sometimes mild itchiness. It can result in social or self-esteem problems. A more severe form of the condition, which includes inflammation of the skin, is known as seborrhoeic dermatitis.

<span class="mw-page-title-main">Sebaceous hyperplasia</span> Medical condition

Sebaceous hyperplasia is a disorder of the sebaceous glands in which they become enlarged, producing flesh-colored or yellowish, shiny, often umbilicated bumps. Sebaceous hyperplasia, primarily affecting older patients in high-concentration areas like the face, head, and neck, typically has a 2-4 mm diameter and causes no symptoms. The lesions are often surrounded by telangiectatic blood vessels, also known as "crown vessels," and a central dell, which is in line with the origin of the lesions.

<span class="mw-page-title-main">Sebaceous gland</span> Gland to lubricate the hair and skin

A sebaceous gland or oil gland is a microscopic exocrine gland in the skin that opens into a hair follicle to secrete an oily or waxy matter, called sebum, which lubricates the hair and skin of mammals. In humans, sebaceous glands occur in the greatest number on the face and scalp, but also on all parts of the skin except the palms of the hands and soles of the feet. In the eyelids, meibomian glands, also called tarsal glands, are a type of sebaceous gland that secrete a special type of sebum into tears. Surrounding the female nipples, areolar glands are specialized sebaceous glands for lubricating the nipples. Fordyce spots are benign, visible, sebaceous glands found usually on the lips, gums and inner cheeks, and genitals.

<span class="mw-page-title-main">Seborrhoeic dermatitis</span> Skin disease

Seborrhoeic dermatitis is a long-term skin disorder. Symptoms include flaky, scaly, greasy, and occasionally itchy and inflamed skin. Areas of the skin rich in oil-producing glands are often affected including the scalp, face, and chest. It can result in social or self-esteem problems. In babies, when the scalp is primarily involved, it is called cradle cap. Seborrhoeic dermatitis of the scalp may be described in lay terms as dandruff due to the dry, flaky character of the skin. However, as dandruff may refer to any dryness or scaling of the scalp, not all dandruff is seborrhoeic dermatitis. Seborrhoeic dermatitis is sometimes inaccurately referred to as seborrhoea.

<i>Cutibacterium acnes</i> Species of bacterium

Cutibacterium acnes is the relatively slow-growing, typically aerotolerant anaerobic, gram-positive bacterium (rod) linked to the skin condition of acne; it can also cause chronic blepharitis and endophthalmitis, the latter particularly following intraocular surgery. Its genome has been sequenced and a study has shown several genes can generate enzymes for degrading skin and proteins that may be immunogenic.

<span class="mw-page-title-main">Rosacea</span> Skin condition, usually on the face

Rosacea is a long-term skin condition that typically affects the face. It results in redness, pimples, swelling, and small and superficial dilated blood vessels. Often, the nose, cheeks, forehead, and chin are most involved. A red, enlarged nose may occur in severe disease, a condition known as rhinophyma.

<span class="mw-page-title-main">Comedo</span> Medical condition

A comedo is a clogged hair follicle (pore) in the skin. Keratin combines with oil to block the follicle. A comedo can be open (blackhead) or closed by skin (whitehead) and occur with or without acne. The word "comedo" comes from the Latin comedere, meaning "to eat up", and was historically used to describe parasitic worms; in modern medical terminology, it is used to suggest the worm-like appearance of the expressed material.

<span class="mw-page-title-main">Neonatal conjunctivitis</span> Medical condition

Neonatal conjunctivitis is a form of conjunctivitis which affects newborn babies following birth. It is typically due to neonatal bacterial infection, although it can also be non-infectious. Infectious neonatal conjunctivitis is typically contracted during vaginal delivery from exposure to bacteria from the birth canal, most commonly Neisseria gonorrhoeae or Chlamydia trachomatis.

Acne medicamentosa is acne that is caused or aggravated by medication. Because acne is generally a disorder of the pilosebaceous units caused by hormones, the medications that trigger acne medicamentosa most frequently are hormone analogs. It is also often caused by corticosteroids; in this case, it is referred to as steroid acne.

<span class="mw-page-title-main">Feline acne</span> Medical condition

Feline acne is a problem seen in cats primarily involving the formation of blackheads accompanied by inflammation on the cat's chin and surrounding areas that can cause lesions, alopecia, and crusty sores. In many cases, symptoms are mild and the disease does not require treatment. Mild cases will resemble dirt on the cat's chin, but the "dirt" will not be brushed off. More severe cases, however, may respond slowly to treatment and seriously detract from the health and appearance of the cat. Feline acne can affect cats of any age, sex, or breed, although Persian cats are also likely to develop acne on the face and in the skin folds. This problem can happen once, reoccur, or even persistent throughout the cat's life.

<span class="mw-page-title-main">Acneiform eruption</span> Medical condition

Acneiform eruptions, or acne mimicking eruptions, are a group of skin conditions characterized by small bumps resembling acne. Typically, these bumps are mostly of similar size. Some bumps may be bigger or contain fluid. Generally, blackheads and whiteheads are absent. It tends to appear suddenly, with the chest and back most frequently affected.

Acne conglobata is a highly inflammatory disease presenting with comedones, nodules, abscesses, and draining sinus tracts.

<span class="mw-page-title-main">Transient neonatal pustular melanosis</span> Medical condition

Transient neonatal pustular melanosis (TNPM), also known as pustular melanosis, is a type of neonatal pustular eruption that is a transient rash common in newborns. It is vesiculopustular rash made up of 1–3 mm fluid-filled lesions that rupture, leaving behind a collarette of scale and a brown macule. The lesions are fragile and with no surrounding erythema. This rash occurs only in the newborn stage, usually appearing a few days after birth, but pigmented macules are sometimes already present at birth. The rash usually fades over three to four weeks but may linger for up to three months after birth. It can occur anywhere on the body, including the palms and soles.

Sclerema neonatorum is a rare and severe skin condition that is characterized by diffuse hardening of the subcutaneous tissue with minimal inflammation.

<span class="mw-page-title-main">Pimple</span> Type of comedo

A pimple or zit is a kind of comedo that results from excess sebum and dead skin cells getting trapped in the pores of the skin. In its aggravated state, it may evolve into a pustule or papule. Pimples can be treated by acne medications, antibiotics, and anti-inflammatories prescribed by a physician, or various over the counter remedies purchased at a pharmacy.

Infantile acne is a form of acne that begins in very young children. Typical symptoms include inflammatory and noninflammatory lesions, papules and pustules most commonly present on the face. No cause of infantile acne has been established but it may be caused by increased sebaceous gland secretions due to elevated androgens, genetics and the fetal adrenal gland causing increased sebum production. Infantile acne can resolve by itself by age 1 or 2. However, treatment options include topical benzyl peroxide, topical retinoids and topical antibiotics in most cases.

Childhood granulomatous periorificial dermatitis (CGPD), is a rare benign granulomatous skin disease of unknown cause. The disorder was first described in 1970 by Gianotti in a case series of five children. CGPD is more common in boys than girls.

Neonatal pustular eruptions are a group of disorders characterized by various forms of pustulosis seen in the first four weeks of life.

References

  1. Holm EA, Jemec GB (December 2000). "[Acne neonatorum/acne infantum]". Ugeskrift for Læger (in Danish). 162 (50): 6856–7. PMID   11187144.
  2. Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN   978-1-4160-2999-1.[ page needed ]
  3. James, William D.; Elston, Dirk; Treat, James R.; Rosenbach, Misha A.; Neuhaus, Isaac (2020). "13. Acne". Andrews' Diseases of the Skin: Clinical Dermatology (13th ed.). Elsevier. p. 231. ISBN   978-0-323-54753-6.
  4. 1 2 3 4 5 6 7 Greydanus, Donald E.; Azmeh, Roua; Cabral, Maria Demma; Dickson, Cheryl A.; Patel, Dilip R. (2021-04-01). "Acne in the first three decades of life: An update of a disorder with profound implications for all decades of life". Disease-a-Month. 67 (4): 101103. doi:10.1016/j.disamonth.2020.101103. ISSN   0011-5029. PMID   33041056. S2CID   222300087.
  5. 1 2 3 4 5 6 7 8 Maroñas-Jiménez, L.; Krakowski, A. C. (2016-04-01). "Pediatric Acne: Clinical Patterns and Pearls". Dermatologic Clinics. 34 (2): 195–202. doi:10.1016/j.det.2015.11.006. ISSN   0733-8635. PMID   27015779.
  6. 1 2 3 4 Gamble, Ryan; Dunn, Jeff; Dawson, Annelise; Petersen, Brian; McLaughlin, Lauren; Small, Alison; Kindle, Scott; Dellavalle, Robert P. (June 2012). "Topical Antimicrobial Treatment of Acne Vulgaris: An Evidence-Based Review". American Journal of Clinical Dermatology. 13 (3): 141–152. doi:10.2165/11597880-000000000-00000. ISSN   1175-0561. PMID   22268388. S2CID   5838346.
  7. 1 2 3 4 5 6 7 8 Chernoff, Karen A.; Zaenglein, Andrea L. (2017), Teng, Joyce M.C.; Marqueling, Ann L.; Benjamin, Latanya T. (eds.), "Disorders of the Sebaceous and Sweat Gland", Therapy in Pediatric Dermatology, Cham: Springer International Publishing, pp. 113–122, doi:10.1007/978-3-319-43630-2_8, ISBN   978-3-319-43628-9 , retrieved 2021-04-19
  8. 1 2 3 4 Herane, Maria Isabel (2014), Zouboulis, Christos C.; Katsambas, Andreas D.; Kligman, Albert M. (eds.), "Childhood Acne", Pathogenesis and Treatment of Acne and Rosacea, Berlin, Heidelberg: Springer Berlin Heidelberg, pp. 227–234, doi:10.1007/978-3-540-69375-8_30, ISBN   978-3-540-69374-1 , retrieved 2021-04-19
  9. Baldwin, Hilary (2014), Zeichner, Joshua (ed.), "Neonatal and Infantile Acne", Acneiform Eruptions in Dermatology: A Differential Diagnosis, New York, NY: Springer, pp. 371–374, doi:10.1007/978-1-4614-8344-1_51, ISBN   978-1-4614-8344-1, S2CID   73751378 , retrieved 2021-04-20
  10. Eichenfield, L. F.; Krakowski, A. C.; Piggott, C.; Del Rosso, J.; Baldwin, H.; Friedlander, S. F.; Levy, M.; Lucky, A.; Mancini, A. J.; Orlow, S. J.; Yan, A. C. (2013-05-01). "Evidence-Based Recommendations for the Diagnosis and Treatment of Pediatric Acne". Pediatrics. 131 (Supplement): S163–S186. doi: 10.1542/peds.2013-0490B . ISSN   0031-4005. PMID   23637225. S2CID   2277620.
  11. Zeichner, Joshua, ed. (2014). Acneiform Eruptions in Dermatology: A Differential Diagnosis. New York, NY: Springer New York. doi:10.1007/978-1-4614-8344-1. ISBN   978-1-4614-8343-4.
  12. 1 2 Ashton, Rosalind; Weinstein, Miriam (November 2019). "Acne Vulgaris in the Pediatric Patient". Pediatrics in Review. 40 (11): 577–589. doi:10.1542/pir.2018-0137. ISSN   0191-9601. PMID   31676531. S2CID   207834296.
  13. 1 2 Zeichner, Joshua, ed. (2014). Acneiform Eruptions in Dermatology: A Differential Diagnosis. New York, NY: Springer New York. doi:10.1007/978-1-4614-8344-1. ISBN   978-1-4614-8343-4.

Further reading