Infantile acne

Infantile acne usually starts after the age of 3 months, with comedones, papules and pustules on the cheeks and chin. For a diagnosis of acne, comedones must be present. See here for a photo of infantile acne. Milia, miliaria and neonatal cephalic pustulosis are commonly misdiagnosed as infantile acne.

Most cases are mild and resolve by the age of 12 months; however, large comedones can leave permanent pits. Infantile acne can progress to more severe cystic disease and scarring.

For sparse comedones with mild inflammatory papules or pustules, and if there is evidence of potential scarring, spot treat with:

• benzoyl peroxide 5% cream or gel topically, once daily. 
• If irritation occurs, change to a lower strength of benzoyl peroxide (eg benzoyl peroxide 2.5%).

For large and numerous comedones with minimal inflammation, use a topical retinoid on the affected area (not just to individual lesions). Use:

• 1adapalene 0.1% cream topically, once daily at night  OR
• 1tretinoin 0.025% cream topically, once daily at night. 

For numerous comedones with inflammatory lesions, use a topical combination of benzoyl peroxide and adapalene on the affected area (not just to individual lesions). Use:

• benzoyl peroxide+adapalene 2.5%+0.1% gel topically, once daily at night.

Benzoyl peroxide and topical retinoids (in combination, or as monotherapy) can potentially cause irritation. If irritation occurs despite using the lowest strength of these topical drugs, refer for dermatologist advice.

If the skin does not clear, refer for dermatologist advice. Some infants need oral erythromycin to treat the inflammatory component of the acne. Occasionally, oral isotretinoin is required.