What Is Baby Acne?

What causes baby acne? My three-week-old has baby acne all over his face, ears, head, and chest, and it’s getting worse by the day! His doctor says it’ll go away on its own. Is there a treatment?

—Lauren

This is such a common concern that at the two-week well visit, I usually warn parents in a little schpiel I give about things that might show up that shouldn’t alarm you.

The short answer is: your doctor is right. Baby acne usually goes away on its own, and most of the time, no treatment is needed. But if you want to dive deeper, there’s a bit of nuance.

Some doctors distinguish between two conditions that can cause inflamed skin in young babies: true neonatal acne and neonatal cephalic pustulosis (NCP). The differences are subtle, and many pediatricians treat them as variations of the same thing, but the distinction is helpful because they likely have different causes.

Neonatal acne is defined by the presence of comedones (blackheads and whiteheads) and is related to hormones.

Here’s a fun physiological fact: if you gently squeeze a two-week-old baby’s nipples — regardless of sex — you might see a drop of breast milk. That’s because newborns are still full of maternal hormones like estrogen, progesterone, and prolactin. Their bodies may be tiny, but hormonally they resemble a pregnant person who is about to breastfeed. That’s why you might see a baby girl with a bit of vaginal discharge or even bleeding, and why her genitalia may look puffy. It’s also why neonatal acne happens — that dramatic hormonal shift after birth can trigger acne just like it does during puberty.

NCP presents with pustules and papules (small red or white bumps). This type has been linked to colonization of a yeast called malassezia, which naturally lives on our skin. In some studies, it’s been associated with acne, skin inflammation, and dandruff. It’s unclear whether the yeast directly causes the bumps, but the theory is that it triggers an inflammatory response.

Both hormones and yeast may play a role, and some babies may have a combination of both. Most pediatricians don’t worry about teasing apart these causes because the outcome is the same: nearly all cases resolve without treatment within one or two months, and almost all are gone by four months. The best course of action is typically to wait it out, and in the meantime you can gently wash your baby’s face with mild soap. Only the most severe cases pose any risk of scarring, and your pediatrician can help identify those rare exceptions.

There is some limited evidence that topical antifungal creams (like ketoconazole) or low-strength steroid creams (like 1% hydrocortisone) can speed up resolution. Because baby acne resolves on its own, I don’t typically recommend these unless the rash is pretty severe and causing distress — usually to the parents, not the baby, who is almost always unbothered.

Whether or not to treat is a personal decision. There’s not much risk to using a topical treatment if needed, but time itself will also cure this nuisance.