Newborn acne: why and what to do

The smooth newborn skin you saw in the first photos has been replaced by a face full of tiny red and white bumps. Welcome to newborn acne. It looks dramatic, especially in good lighting. It is also one of the easiest skin issues to manage — which is to say, don't manage it at all.

What newborn acne looks like

Classic features:

• Small red or pink bumps on cheeks, forehead, chin, sometimes scalp.
• White or yellow whitehead-like tops on some bumps.
• Often clusters together, with patches of clear skin in between.
• Can look worse when baby cries or after warm baths as blood flow to the face increases.
• Sometimes spreads to neck or upper chest.
• Skin around the bumps is not red or angry-looking.

It does not itch baby. It does not hurt. It looks worse to you than it feels to them.

Why it happens

Most newborn acne is thought to come from leftover maternal hormones still circulating in baby's body. These hormones stimulate baby's oil glands, similar to teenage acne. The glands get blocked, and you get bumps.

Some research also points to a normal skin yeast (Malassezia) playing a role, similar to its part in cradle cap. Either way, the cause is internal, not anything in baby's environment or your skincare.

Newborn acne is more common than you'd think — about 20% of babies get it. It is more common in boys than girls but happens to both.

The timeline

• Week 0 to 2: skin usually clear. Maternal hormones still adjusting.
• Week 2 to 4: first bumps appear.
• Week 4 to 6: peak. Worst it'll look.
• Week 6 to 12: gradual clearing.
• By 3 to 4 months: usually fully resolved.

Some babies have a quick episode of acne that clears in 2 weeks. Others have a longer one that lingers until 4 to 6 months. Both are normal as long as the skin around the bumps stays calm.

What to do (and not do)

Do:

• Wash with warm water once a day. Plain water and a soft cloth. No scrubbing.
• Pat dry gently. Don't rub.
• Keep baby cool. Overheating can flare the acne. Light layers, not heavy ones.
• Wash your shirts if baby is drooling or spitting up on you and pressing face against you a lot — keep contact areas clean.
• Use fragrance-free, mild baby products if you use any at all.

Don't:

• Don't use adult acne products. Salicylic acid, benzoyl peroxide, retinol — none of these are safe for newborn skin. They can cause chemical burns and irritation.
• Don't scrub. The bumps are blocked oil glands, not dirt. Scrubbing irritates skin further.
• Don't pinch, pick, or squeeze. Can cause scarring and infection.
• Don't apply lotions, oils, or creams to the affected area unless your pediatrician recommends.
• Don't use breast milk on it. A popular folk remedy, but no real evidence it helps. Breast milk can also clog the bumps further.

Newborn acne vs other newborn rashes

A few things look similar but aren't newborn acne. Here's how to tell them apart:

Milia

Tiny white bumps, usually on the nose, cheeks, or chin. Look like little pinhead-sized pearls. Not red around them. Milia are blocked sweat glands, not acne. They clear on their own in a few weeks. No treatment.

Erythema toxicum

Splotchy red areas with small yellow or white bumps in the center. Comes and goes in different spots within hours. Most common in the first week of life. Despite the scary name, it's harmless and resolves within a couple of weeks. No treatment.

Heat rash (miliaria)

Tiny pink or clear bumps in areas where baby gets sweaty — neck folds, armpits, groin, diaper area. Improves when baby cools off.

Eczema

Dry, scaly, red patches, often on cheeks, scalp, behind knees, inside elbows. Itchy. Baby may try to scratch (even if they can't reach well). Eczema needs management — see your pediatrician.

Hand foot and mouth disease

Red or grayish-white bumps with red edges, usually on palms, soles, around the mouth. Often with fever and fussiness. Caused by a virus. See pediatrician.

Hives

Raised red welts that change shape and location quickly. Often itchy. Suggest an allergic reaction. Call pediatrician.

When acne might be something else

If the bumps:

• Cover large areas of the body (not just face/scalp/upper chest)
• Have angry red, weepy, or pus-filled centers
• Appear with fever or fussiness
• Spread rapidly over hours
• Have a clear pattern related to a specific exposure (new soap, food, fabric)
• Don't improve by 4 to 6 months

...send a photo to your pediatrician or go in. Could be eczema, an infection, or a different rash that needs treatment.

Will newborn acne leave a mark?

No. Newborn acne doesn't scar when left alone. Picking or scrubbing can cause scarring, but the bumps themselves resolve without a trace. The skin underneath will look completely smooth once the acne is fully gone.

Diet and newborn acne

If you're breastfeeding, you may wonder if something in your diet caused the acne. Almost certainly not. Newborn acne is hormonal, not dietary. There's no need to eliminate foods from your diet to address it.

If you're formula feeding, the formula brand is also not the cause. Newborn acne is just as common in formula-fed babies.

Photos and newborn acne

The most common question from parents in the throes of newborn acne: "Can I still take photos?" Yes. The photos will be cute regardless. If you want clear skin photos, schedule sessions around week 1 (before acne starts) or after 3 to 4 months (once it's resolved). In between, embrace the bumpy face — it's a defining newborn feature.

When to call your pediatrician

• The rash spreads significantly across baby's body.
• You see weepy, pus-filled, or open sores.
• Baby has fever along with the rash.
• Baby seems uncomfortable, fussy, or scratching at the rash.
• The rash hasn't improved at all by 4 to 6 months.
• You're not sure if it's newborn acne or eczema/infection.