Baby acne: why newborns get pimples, and why it passes

You finally get those first newborn photos, and a few weeks later your baby’s cheeks are covered in little red pimples. It’s one of the most common surprises of early parenthood. The reassuring news: newborn pimples are usually harmless, they don’t mean anything is wrong with your care, and they clear up on their own.

How common is baby acne?

Very. The American Academy of Dermatology (AAD) says about 20% of newborns get baby acne, also called neonatal acne. It usually appears at about two weeks of age, and can start any time before six weeks.

The bumps are most often on the cheeks and nose, but they can also show up on the forehead, chin, scalp, neck, back or chest. They look like small red pimples, sometimes with a white or yellowish tip.

Not every newborn pimple is acne

Several harmless conditions look alike on a newborn’s face. Knowing which is which helps you worry less. A quick way to start: look closely for blackheads or whiteheads, check whether the bumps are red or pearly white, and note how old your baby was when they appeared.

Neonatal cephalic pustulosis

Despite the long name, this one is simple. Neonatal cephalic pustulosis is a rash of small pimples and pustules (pimples with a white or yellow head) on the face and scalp, often starting in the third week of life. DermNet, a dermatology reference from New Zealand, says it is related to Malassezia, a yeast that normally lives on skin. What sets it apart from true acne is that there are no comedones, the blackheads and whiteheads that come from plugged pores. It usually clears without any treatment.

True neonatal acne

True acne in a newborn does include comedones, along with red bumps. It too is temporary. An expert consensus of paediatric dermatologists published in 2020 defines neonatal acne as acne appearing from birth to eight weeks.

Milia

Milia are tiny, pearly white bumps, like grains of sand, usually on the nose, chin and cheeks. DermNet says about half of all babies have them, and most clear within the first four weeks of life. They’re not pimples and aren’t red or inflamed. Similar little white bumps can appear on the gums or the roof of the mouth. The Canadian Paediatric Society describes milia as tiny whiteheads that disappear on their own.

Newborn rash (erythema toxicum)

Not acne either, but often confused with it. DermNet says this rash affects about half of full-term newborns. It appears in the first few days of life as scattered pink or red blotches, often with small bumps, and each spot fades within a day or two.

Caring for your baby’s skin: less is more

All of these conditions go away on their own, and the most helpful thing you can do is avoid making the skin more irritated. The AAD recommends:

• Wash your baby’s face with lukewarm, not hot, water.
• Be very gentle, and don’t scrub. Pat the skin dry with a soft towel.
• Stop using oily or greasy products on the face, including lotions and oils.
• Never put acne medicine or acne wash on your baby’s skin unless your child’s dermatologist or paediatrician recommends it.

A few more tips:

• Don’t squeeze, pick or pop the bumps.
• Wash anything that touches the face often, like burp cloths, and use a fragrance-free detergent.

If you’re looking for a gentle wash for the rest of your baby’s routine, our baby care list is a place to start. For the face, water is usually enough.

How long does it last?

The Canadian Paediatric Society puts it simply: baby acne goes away on its own within a few weeks, without any special treatment. The AAD agrees, saying neonatal acne tends to go away on its own within a few weeks to a few months, and rarely leaves a scar. Neonatal cephalic pustulosis generally clears without treatment. Milia typically disappear within the first month.

If a doctor decides the yeast-related rash is worth treating, DermNet notes that a gentle antifungal cream can be used safely. That’s a decision for your doctor, not something to try from the pharmacy shelf.

When to ask a doctor

Most baby acne needs nothing more than patience. But talk to your doctor or nurse practitioner if:

• Acne starts after about six weeks of age. The AAD calls this infantile acne; it typically begins between three and six months and can last six months to a year. The AAD recommends seeing a dermatologist to rule out an underlying health problem and to prevent scarring.
• The bumps are large, deep or painful, or look like they might scar.
• The spots are filled with fluid, form clusters of blisters, or spread quickly.
• Your baby has a fever, is feeding poorly or seems unwell.
• The rash isn’t improving after a few weeks, or you’re not sure what it is.

Acne in toddlers and young children, between one and seven years, is its own category. The 2020 expert consensus advises health care providers to watch for hormone-related problems in children with acne at that age, so it’s worth a doctor’s visit.

Blisters, a fever, or a baby who seems sick are never part of normal baby acne. Those deserve a same-day call.

Baby acne is common, temporary and harmless. Wash gently with lukewarm water, skip the creams and the scrubbing, and let your baby’s skin settle on its own. If the pimples appear after six weeks, look deep or painful, or come with a fever or blisters, check in with your doctor.