In over 20 years of practice I have not noted any difference in incidence of
neonatal acne between breastfed and artificially-fed infants. (Good research
study for someone!) Below is section on this topic from the experts:
Textbook of Neonatal Dermatology by Eichenfeld (one of my partners), Frieden
and Easterly, WB Saunders, 2001, pg 94-95:
"Neonatal and Infantile Acne
Neonatal and infantile acne are distinct entities distinguishable by time of
onset and clinical features, Neonatal acne may occur at birth and usually
appears within the first 2 to 3 weeks of life. This disorder is currently
under close scrutiny as to its existence and/or etiology: is it acne or
another pustular disorder of infancy? The term neonatal cephalic pustulosis
has been proposed to replace the term neonatal acne. Classically, neonatal
acne has been described as inflammatory, erythematous papules and pustules,
located primarily on the cheeks but scattered over the face and often
extending onto the scalp. Comedonal lesions are absent. There has been a
recent hypothesis that these erythematous papulopustules seen in the first
month of life may be an inflammatory reaction to Pityrosporum(Malassezia)
species, both M. furfur and M. sympodialis. In addition, clinical
differentiation between neonatal acne and miliaria rubra maybe impossible.
Biopsies would aid in diagnosis, but they are not justified,since both
conditions are benign and transient. A later form of acne has been termed
infantile acne. This may be due to a persistence of neonatal acne or a later
onset oftrue acne at 2 to 3 months of age. Infantile acne shows typical
acneiform lesions, including open and closed comedones, as well as papules,
pustules, and occasionally nodules. It is found primarily on the face.
Infantile acne has been considered to be an androgen-driven condition with
hyperplasia of sebaceous activity. It rarely may be a sign of underlying
androgen excess such as congenital adrenal hyperplasia,steroid-producing
gonadal or adrenal tumor, or true precocious puberty. There is usually
spontaneous resolution in the first 6 to 12 months of life. This would
correlate well with what is known about neonatal androgens. The fetal adrenal
gland is really an enlarged zona reticularis, which is the androgen-producing
zone of the adrenal, producing pubertal levels of
dehydroepiandrosterone(DHEA) and its sulfate (DHEAS), which wane over the
first 6 months of life in both male and female infants. In the male infant,
testicular testosterone is also elevated for the first 6 to 12 months of
life, perhaps explaining the observation that males are more affected with
infantile acne than females. Whereas neonatal acne spontaneously resolves
without treatment, infantile acne may be more persistentand even cause
scarring and can benefit from treatment. Small inflammatory papules and
pustules respond to topical benzoyl peroxide or erythromycin.Topical
tretinoin in low concentrations (0.01% gel or 0.025% cream) can be used for
open and closed comedones. Erythromycin is the only appropriate systemic
antibiotic for larger papules or pustules that may scar. Tetracyclines are
contraindicated because they cause permanent tooth staining. In those rare
cases of severe, scarring nodular infantile acne, systemic isotretinoin has
been used safely and effectively."
Nancy
Nancy E. Wight MD, FAAP, IBCLC
Neonatologist, Children's Hospital, and Sharp Mary Birch Hospital for Women
Medical Director, Lactation Services, Sharp HealthCare
San Diego, CA, USA
Office: 858-541-4180
Fax: 858-541-4135
Pager: 858-493-0198
Email: [log in to unmask]
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