Case of the Month with Crutchfield Dermatology

Wednesday, September 3, 2014

Presentation: A 5-week-old boy developed red papules and pustules on his face, most notably his cheeks. The lesions were first noted by the parents four weeks after birth.

Diagnosis: Neonatal Cephalic Pustulosis (Neonatal Acne, Infantile Acne)

Neonatal cephalic pustulosis is a harmless skin condition seen in infants from birth to approximately 8 months old. The working hypothesis is that the mother’s hormones are actively and harmlessly functioning within the infant, causing the sebaceous oil glands to clog and the acne to appear very much as it does in adolescence. Others feel that pityrosporum may also be involved in the etiology in the shorter-lived type. Boys tend to be affected more than girls, but both get the condition. Some cases resolve rapidly without any intervention, and others are longer lasting. The definitive nomenclature has not been determined. However, some call the shorter-lived version (possibly linked to pityrosporum) neonatal acne and the longer-lived version (possibly linked to maternal hormones) infantile acne. Both are subtypes of neonatal cephalic pustulosis.

Neonatal cephalic pustulosis is most commonly first noted at about weeks two to four but can occur up to six to eight months after birth. Although it is harmless and most cases clear up in a few weeks or months, most parents want to treat it because of its disturbing and unsightly appearance.

In this particular case, I prescribed Cleocin lotion to be applied sparingly twice daily. I also recommended no other “read-about-online” or “grandmother-, friend- or neighbor-recommended” treatments — only a gentle non-detergent cleanser (Vanicream Cleansing Bar) with a cotton washcloth, as needed, and CeraVe lotion for moisturization, PRN.

The parents reported a significant and acceptable improvement approximately 14 days after the initiation of treatment.

For additional information, contact Charles E. Crutchfield III, MD, at Crutchfield Dermatology, or visit