Neonatal acne is present at birth or appears shortly after. It is more common than fully appreciated; if the diagnosis is based in a few comedones more than 20% of newborns are affected . The most common lesions are comedones, papules and pustules. They are few in number and usually localized on the face, more often cheeks and forehead. Involvement of the chest, back or groins has been reported. Most cases are mild and transient. Lesions appear mainly at 2-4 weeks healing spontaneously, without scarring, in 4 weeks to 3-6 months. Neonatal acne has been suggested to be more frequent in male infants [2, 3].
The pathogenetic mechanisms of neonatal acne are still unclear. A positive family history of acne supports the importance of genetic factors. Familial hyperandroge-nism including acne and hirsutism give the evidence that maternal androgens may play a role through transplacen-tal stimulation of sebaceous glands . There is a considerable sebum excretion rate during the neonatal period which decreases markedly to almost not detectable levels following the significant reduction of sebaceous gland volume up to the age of 6 months [5-7]. There is a direct correlation between high maternal and neonatal sebum excretion suggesting the importance of maternal environment on the infant sebaceous glands . Neonatal adrenal glands produce a certain amount of P-hydroxysteroids that prepare the sebaceous glands to be more sensitive to hormones in the future life . In males from 6 to 12 months there are increasing levels of luteinizing hormone (LH) and as a consequence of testosterone; these andro-gens plus those of testicular origin partially explain the male predominance of neonatal and infantile acne [3, 9].
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Prof. Maria Isabel Herane
Department of Dermatology, West Unit, Hospital San Juan de Dios Guardia Vieja 255 of. 901 Providencia, Santiago (Chile)
Tel. +56 2 331 04 49, Fax +31 2 331 04 50, E-Mail [email protected]
The differential diagnosis include milia, miliaria, sebaceous gland hyperplasia, bilateral naevus comedonicus, acneiform eruptions due to the use of topicals, oils and ointments, to maternal medications (lithium, hydantoin, steroids), or due to virilizing luteoma in pregnancy [1, 10, 11]. Deficiency of the 21-hydroxylase and adrenal cortical hyperplasia should also be considered . Neonatal acne can also be confused with cephalic pustulosis due to mal-assezia species (mainly Malassezia sympodialis). Clinically the lesions are very similar to acne and are a consequence of an overgrowth of these lipophilic yeasts (on a neonate with high sebum production) that leads to an inflammatory reaction and poral or follicular occlusion. Its response to ketoconazole cream 2% is significant [13-15].
The treatment of neonatal acne begins with reassurance of parents. Topical treatments for comedones include retinoids such as tretinoin (cream 0.025-0.05%) or azelaic acid (cream 20%) daily or in alternating days. For inflammatory lesions, topical antibiotics (erythromycin 4% pads, pledgets, cream, gel) and benzoyl peroxide (wash, gel 2.5%) are useful .
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