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• Papulopustular lesions on the palms and/or soles in the first month of life likely represent a self-limited inflammatory process such as eosinophilic pustular folliculitis or infantile acropustulosis – but scabies should be ruled out. • Neonatal acne (aka cephalic pustulosis) is typically multifactorial and self-limited. Treatment is not necessary but topical agents aimed at reduction of the commensal yeast Malassezia can be beneficial. • Evidence suggests that early use of emollients in infants at risk of developing atopic dermatitis may prevent later disease. • Subcutaneous fat necrosis of the newborn is generally benign and self-limited but when extensive can cause hypercalcemia.

Introduction: According to WHO a neonate, is a child under 28 days of age. The neonatal skin changes show a wide geographic and ethnic variation. It is important to know the pattern of dermatoses prevalent among Indian children during the neonatal period. Aims a nd Objectives: The current study was conducted to study the prevalence of neonatal dermatoses in southern Assam and to study relationship of neonatal dermatoses with maturity and birth weight of neonates. Materials and Methods: 150 neonates who developed cutaneous lesions over a period of one year were examined. Proportion of each dermatoses and prevalence ratio were calculated using relevant formulae. Results: Out of the 150 neonates, 66 % neonates had transient physiological changes, 11.33% had congenital disorders and genodermatoses, 4.67% had iatrogenic complications, 30% had acquired skin diseases, 8% had neonatal infections and 2% had other miscellaneous diseases. The five most common dermatoses overall were diaper dermatitis (17.33%), miliaria (14%), erythema toxicum neonatorum (13.33%), infantile seborrheic dermatitis (12.67%), sebaceous gland hyperplasia (6%) and Mongolian spot (6%). Low birth weight babies had predilection for vernix caseosa, sucking blisters, candidiasis, miniature puberty, caput succedaneum, cephalohematoma, physiological jaundice, infantile acropustulosis, salmon patch, Epstein’s pearls/ Bohn’s nodules, miliaria, sebaceous gland hyperplasia, neonatal acne, Mongolian spot, bullous impetigo, erythroderma Preterm neonates had predilection for vernix caseosa, sucking blisters, miniature puberty, candidiasis, Mongolian spot, caput succedaneum, cephalohematoma, erythroderma, miliaria, Epstein’s pearls/ Bohn’s nodules and a positive association was seen between post-term neonates and physiological desquamation, diaper dermatitis. Neonatal psoriasis and neonatal dermatophyte infection were the unusual findings which we found in our study. Keywords: Erythema T

Background Neonatal acne occurs in the first few weeks after birth. Some lesions are more serious and leave scars. Maternal surface skin lipids (SSL) have a strong correlation with SSL of infants. The establishment of prediction rank model based on maternal SSL is essential to the prevention and treatment of neonatal acne. Method Surface skin lipids samples were collected from the mothers (M) of 56 neonatal acne patients and the mothers (HM) of 19 healthy infants. Surface skin lipids from the right forehead were collected using a noninvasive method. UPLC-QTOF-MS was applied to detect SSL. Partial least squares discriminant analysis and receiver operating characteristic (ROC) analysis were performed to screen and validate potential lipids. Random forest (RF) and ROC analysis were used to establish a prediction model and evaluate its accuracy. Results Sixteen altered potential lipids belonging to fatty acids, sphingomyelins, and glycerides were associated with M. M had less lipids than HM. Spearman's correlation of 16 lipids revealed 9 with high correlation. They were chosen as characteristic values of the RF prediction model. And the model showed an average accuracy of 98% in the validation set. Conclusion We have established an RF model for predicting neonatal acne and have shown that high skin barrier-related lipids were markers for predicting neonatal acne.

Acne Vulgaris: Management , published on 25 June 2021, is a National Institute for Health and Care Excellence (NICE) guideline for patients with acne, their families and carers, their healthcare professionals, and commissioners.1 It does not consider neonatal acne. This article highlights parts of the guideline that cover skin care advice and first-line medication options in the management of acne. The guideline also covers further areas such as ‘Referral to specialist care’, ‘Oral isotretinoin’, Physical treatment’, ‘Relapse’, Maintenance treatment’, and ‘Management of acne-related scarring’, which will not be covered in this article. Acne vulgaris is one of the commonest inflammatory skin conditions, reported to create 3.5 million general practice consultations per year in the UK.2 It usually affects adolescents and young adults, and can last for several years. Acne vulgaris most commonly affects the face but chest, back, and shoulders may be involved. Lesions are a combination of non-inflammatory (comedones) and inflammatory lesions (papules, pustules, cysts, nodules), often leading to scarring. The committee agreed to grade acne vulgaris into ‘Mild to Moderate’ or ‘Moderate to Severe’ in order to conduct separate network meta-analysis, while accepting that acne lies along a continuum. This is easily accomplished in busy clinics and provides a baseline for assessing treatment response. Mild-to-moderate acne vulgaris includes patients who have one or more of

The objective of this review is to help practitioners of neonatal and pediatric medicine become more familiar with diagnosing and managing neonatal skin conditions. This article will discuss normal neonatal skin care and benign and common rashes, as well as some of the serious dermatologic conditions that require specialists for further evaluation and/or treatment.

Acne is a common disease, and its diagnosis is usually easy. In this chapter, not only unusual or special types of acne but also acne-like diseases that are clinically and etiologically different from acne vulgaris are discussed. The former category includes neonatal acne, acne conglobata, acne fulminans, cosmetic acne, acne excoriee, steroid acne, chloracne, hormonal acne including polycystic ovary syndrome, drug-induced acne, SAPHO syndrome, and so on. The other category is represented by rosacea, perioral dermatitis, folliculitis including Malassezia folliculitis and demodicosis, sycosis barbae, eosinophilic folliculitis, acneiform eruption due to anti-EGFR drugs or other anti-cancer drugs, and other non-follicular diseases such as lupus miliaris disseminatus faciei.

El acné neonatal es una dermatosis transitoria que ocurre entre la segunda y la cuarta semanas de vida en uno de cada cinco niños. Es más frecuente en los varones, con una relación de sexo masculino-femenino de 4.5:1. Las manifestaciones clínicas incluyen comedones abiertos y cerrados que pueden progresar a lesiones inflamatorias como pápulas, pústulas eritematosas y, en casos raros, nódulos y quistes. Las zonas afectadas incluyen la frente, las mejillas, el mentón y los párpados, y en algunas ocasiones puede extenderse a la piel cabelluda, el cuello y el tronco. Ocurre por la mayor producción de andrógenos placentarios y neonatales (de origen suprarrenal en ambos sexos y de origen testicular en los varones), que provoca hipertrofia de las glándulas sebáceas y mayor producción de sebo. La mayoría de los casos son leves y autolimitados. Cuando el acné neonatal es grave y prolongado, se debe considerar la posibilidad de hiperandrogenismo, cuyas causas más frecuentes en esta edad son la hiperplasia suprarrenal congénita y los tumores, adrenales o gonadales, productores de andrógenos. El diagnóstico del acné neonatal es clínico: se debe distinguir de la pustulosis cefálica neonatal, otras dermatosis neonatales vesiculopustulares, enfermedades infecciosas y reacciones acneiformes. Habitualmente, un dermolimpiador suave y agua resultan suficientes para su manejo. Las lesiones obstructivas (comedones abiertos y cerrados) pueden requerir retinoides tópicos o ácido azelaico al 20%, y las lesiones inflamatorias, algunos antibióticos tópicos.

Objectives: The objective of this study is to understand knowledge, attitudes and practices of non-nutritional breast milk use among lactating women in respect of skin diseases and other frequent ailments. Material and methods: The study, in the form of a questionnaire, spread on social media, was targeted at breastfeeding women. The questionnaire consisted of questions regarding the knowledge of non-nutritional usage of human milk, its use in practice, subjective opinion on the observed results and inclination towards future use. Chi-square tests and c-Pearson coefficients were used for statistical calculations. Results: A total of 1187 responses were acted upon. In the study group, 879 women claimed to have knowledge of non-nutritional use of human milk in respect of skin and most common ailments, whilst 688 of them claimed to use at least one usage. The most frequently, breast milk was used for: care of cracked nipples, care of healthy skin, treatment of diaper dermatitis and treatment of neonatal acne. A correlation between duration of breastfeeding (p < 0.05) and gestational age (p < 0.05) and practical use of non-nutritional human milk was found. Conclusions: The study showed a great enthusiasm of mothers in respect of using breast milk for non-nutritional purposes, including the treatment of skin diseases and other common ailments. However, given the scant studies determining possible concerns surrounding these methods, there is a requirement for parental education with emphasis on the need for prompt medical examination and pertinent treatment.

Several rashes can present in early infancy, including atopic dermatitis (eczema), seborrheic dermatitis, and neonatal acne. However, these rashes typically present after 2–4 weeks of age.

Acne vulgaris is a chronic, inflammatory, skin condition that involves the pilosebaceous follicles and is influenced by a variety of factors including genetics, androgen-stimulation of sebaceous glands with abnormal keratinization, colonization with Cutibacterium acnes (previously called Propionibacterium acnes), and pathological immune response to inflammation. Acne can occur at all ages and this discussion focuses on the first three decades of life. Conditions that are part of the differential diagnosis and/or are co-morbid with acne vulgaris are also considered. Acne in the first year of life includes neonatal acne (acne neonatorum) that presents in the first four weeks of life and infantile acne that usually presents between 3 and 6 months of the first year of life with a range of 3 to 16 months after birth. Acne rosacea is a chronic, inflammatory, skin condition that is distinct from acne vulgaris, typically presents in adults, and has four main types: erythemato-telangiectatic, papulopustular, phymatous and ocular. Treatment options for acne vulgaris include topical retinoids, topical benzoyl peroxide, antibiotics (topical, oral), oral contraceptive pills, isotretinoin, and others. Management must consider the increasing impact of antibiotic resistance in the 21st century. Psychological impact of acne can be quite severe and treatment of acne includes awareness of the potential emotional toll this disease may bring to the person with acne as well as assiduous attention to known side effects of various anti-acne medications (topical and systemic). Efforts should be directed at preventing acne-caused scars and depigmentation on the skin as well as emotional scars within the person suffering from acne.

1. Alexander Hogan, MD* 2. Deirdre Fearon, MD† 3. Frances Turcotte Benedict, MD, MPH† 1. *Department of Pediatric Hospital Medicine, The Children’s Hospital at Montefiore, Bronx, NY. 2. †Department of Pediatrics and Emergency Medicine, Hasbro Children's Hospital, Providence, RI. An 11-week-old boy presents with a 3-week history of a diffuse papular rash. The rash initially appeared on his trunk, subsequently spreading to the scalp, face, and extremities, including the palms and soles. The infant had a normal spontaneous vaginal delivery following a benign prenatal course. He is exclusively breastfed and feeding and growing well. He was initially seen and evaluated by his pediatrician, who diagnosed neonatal acne. However, as the rash progressed, the pediatrician sent the patient to the emergency department for evaluation. There are no known sick contacts, and no one else living with the infant has a rash. Physical examination reveals a nondysmorphic, well-appearing infant with benign examination findings apart from mild hepatomegaly and a diffuse papular rash (Fig. 1). When unroofed, a small amount of a milky white liquid is expressed. Vital signs are within normal limits for age and the patient’s weight is at the 50th percentile for age. Figure 1. Diffuse papulopustular lesions on feet with no underlying erythema or excoriation. The patient’s initial laboratory results appeared grossly abnormal. The …

Neonatal acne is considered to be a common condition of newborns. The major controversy in this age group is whether the lesions truly represent acne or one of a number of heterogeneous papulopustular acneiform conditions typically without comedones, such as transient neonatal pustular melanosis or colonization with Malassezia species as neonatal cephalic pustulosis or pityrosporum folliculitis. Controversies in neonatal acne pathogenesis, clinical presentation, and treatment will be discussed in this chapter.

Acne is the most common skin disease. Distinguishing between true acne vulgaris and the various acneiform eruptions is important yet sometimes challenging. Given the common nature of acne and acneiform eruptions, the pediatrician must be aware of these lesion patterns and possess the skills to effectively evaluate the pediatric presentation of these eruptions. This article discusses several of the most common acneiform eruptions, including neonatal acne and cephalic pustulosis, periorificial dermatitis (perioral dermatitis), facial angiofibromas, iatrogenic acneiform drug eruptions, and childhood rosacea. [ Pediatr Ann . 2015;44(8):e188–e193.]

Acne is one of the most common dermatologic concerns in adolescents of all skin types. The incidence of pediatric acne is also increasing with early onsets of adrenarche, especially in certain ethnic groups. Notably, there are some vital differences in the presentation of acne in children and in patients with skin of color. Despite the increasing awareness of acne in skin of color, research in this population, especially in the pediatric age group, is still sparse. Most recommendations are based on expert opinion and small studies. The principles of acne treatment are the same within age groups and skin types, but creating age-appropriate treatment plans and managing the sequelae of acne, hyperpigmentation and scarring can be the most challenging in skin of color patients.

Acne is a disease that can be seen in the first year of life, early childhood, prepubertal age, and puberty. The purpose of this article is to review the clinical presentation and pathogenesis of the various forms of prepubertal acne and to propose guidelines regarding its evaluation and treatment. The early clinical recognition of the disease and prompt initiation of therapy in these age groups will help prevent the sequelae of emotional distress and severe scarring in both the child and parents.

Acne is one of the most common skin diseases. Many epidemiologic studies and twin studies have provided substantial evidence about the genetic influence in the development of acne [1–5], at least in certain stages of acne such as neonatal acne, teenage acne [6], adult persistent acne, or in special forms of acne such as acne comedonica, acne inversa [7, 8], acne fulminans [9], or in acne severity [10] and therapeutic resistance [11]. Acne is very likely mediated by polygenic inheritance or multifactorial inheritance attributed to the interplay between multiple genes and the environment, especially the sex hormones. It is unknown if each candidate “acne gene” contributes equally or additively to the disease phenotype, or whether there exists a master gene that presides or leads the disease development. All the candidate genes may influence each other and perpetuate the disease process. The problem in many of the existing epidemiologic studies may include (1) a small sample size with single or few families examined without matched control; (2) lack of standardization in the disease definition or severity classification; (3) variability of age onset, duration, course, and psychosocial influence.

The diagnosis of a pustular dermatosis occurring during the first months of life is usually based on clinical findings. However, some cases may require simple investigations including microscopic examination of pustular content, cultures, and skin biopsies. The main benign transient neonatal types of pustulosis include erythema toxicum neonatorum, infantile acropustulosis, transient neonatal pustular melanosis, and neonatal acne. The most common causes of infectious pustular skin lesions include bacterial infections, which may be initially localized (Staphylococcus aureus) or septicemic (with Listeria monocytogenes as the leading causitive agent); viral infections (herpes simplex, varicella-zoster, and cytomegalovirus infections); fungal infections (candidiasis); or parasitic disorders (scabies). The main objective of this article is to propose a systematic approach to pustular eruptions in the neonate. The need for investigating every neonate with pustules for an infectious disease is emphasized. The Tzanck smear, the Gram's stain, and a potassium hydroxide preparation are the most important quick diagnostic tests. The Tzanck smear is a very easy, rapid, and sensitive test for detection of a herpetic infection (multinucleated giant cells) as well as noninfectious pustular eruptions (eosinophils, neutrophils). Therefore the Tzanck smear should be the first test performed. Moreover, a Gram's stain and potassium hydroxide preparation should be performed in cases of neonatal pustular disorders to detect bacterial and fungal infections. The goal of this diagnostic approach is to spare a healthy neonate with a benign transient condition an invasive evaluation for sepsis, potentially harmful antibiotic therapy, and prolonged hospitalization, with its own inherent morbidity.

Acne vulgaris is a disease that typically affects teenagers but may continue into adulthood in some cases. However, acneiform eruptions can occur in the pediatric population from birth onward. Neonatal acne refers to lesions that develop in the neonatal period, from birth through 4 weeks old. Some consider neonatal acne to be synonymous with neonatal cephalic pustulosis. Infantile acne refers to the acneiform eruption that typically presents in children between 1 month and 1 year old [1]. Making the correct diagnosis can be a challenge, and in some cases the diagnosis of infantile acne is given whenever comedones are clinically present even if the patient is a neonate.

INTRODUCTION: Acne vulgaris is one of the most common skin conditions in children and adolescents. The presentation, differential diagnosis, and association of acne with systemic pathology differs by age of presentation. Current acknowledged guidelines for the diagnosis and management of pediatric acne are lacking, and there are variations in management across the spectrum of primary and specialty care. The American Acne and Rosacea Society convened a panel of pediatric dermatologists, pediatricians, and dermatologists with expertise in acne to develop recommendations for the management of pediatric acne and evidence-based treatment algorithms. METHODS: Ten major topic areas in the diagnosis and treatment of pediatric acne were identified. A thorough literature search was performed and articles identified, reviewed, and assessed for evidence grading. Each topic area was assigned to 2 expert reviewers who developed and presented summaries and recommendations for critique and editing. Furthermore, the Strength of Recommendation Taxonomy, including ratings for the strength of recommendation for a body of evidence, was used throughout for the consensus recommendations for the evaluation and management of pediatric acne. Practical evidence-based treatment algorithms also were developed. RESULTS: Recommendations were put forth regarding the classification, diagnosis, evaluation, and management of pediatric acne, based on age and pubertal status. Treatment considerations include the use of over-the-counter products, topical benzoyl peroxide, topical retinoids, topical antibiotics, oral antibiotics, hormonal therapy, and isotretinoin. Simplified treatment algorithms and recommendations are presented in detail for adolescent, preadolescent, infantile, and neonatal acne. Other considerations, including psychosocial effects of acne, adherence to treatment regimens, and the role of diet and acne, also are discussed. CONCLUSIONS: These expert recommendations by the American Acne and Rosacea Society as reviewed and endorsed by the American Academy of Pediatrics constitute the first detailed, evidence-based clinical guidelines for the management of pediatric acne including issues of special concern when treating pediatric patients.

Neonates or new-born are the most delicate group among kids as they are not able to express their feelings happiness, sad, pain or discomfort and their systems are immature, just starting to adjust to the extra uterine life. Mother plays an important role in identifying minor developmental deviations and early evidence of the disease process because she is constantly and closely watching her baby. The most common minor problems occur in new-borns are vomiting, constipation, diarrhea, breath holding spells, cradle crap, physiological jaundice, hiccups, napkin rash, abdominal colic, oral thrush, erythema toxicum (new-born rash), milia, Epstein pearl, neonatal acne, neonatal conjunctivitis etc. Neonatal infections and the minor problems is one of the major leading causes of death during the neonatal period. It can contribute up to 13–15% of all deaths during the neonatal period with the mortality rate reaching as high as 50% for infants who are not treated timely. Postnatal Mothers should be aware of common minor neonatal problems A quantitative approach was used to study the effectiveness of PTP on the knowledge regarding common minor neonatal problems and its management among postnatal mothers admitted in S.S hospital, Davangere, Karnataka. 30 postnatal mothers admitted in S.S Hospital were selected for the study by purposive sampling technique. Data was collected from samples using 2 tools those are socio demographic variables and structured knowledge questionnaire on common minor neonatal problems and its management. The investigator collect data from Postnatal mothers using structured knowledge Questionnaire. Investigator administers pretests questionnaires to the postnatal mother and then Structured Teaching Programme was given to the postnatal mother and post test was conducted from postnatal mother on 7th day after the intervention. The result revealed that the majority of postnatal mothers had average pretest scores that is 29(99%) and 1(1%) of postnatal mothers had poor knowledge regarding common minor neonatal problems. The mean knowledge scores in pre-test was 1.32 and SD was 0.469 and in post-test mean was 1.52 and SD was 0.499. So, it is evident that mean post-test knowledge score of postnatal mothers was significantly greater than their mean pre-test knowledge score. t’ {1199} = 10.572 at P

The skin of neonates and infants differ from adults in the following ways: In neonates and during early infancy, the skin defenses are not fully developed, the skin is vulnerable to physical, chemical, and microbial attack. The surface area to the weight ratio is higher than at other times of life; there is a greater hazard from increased absorption of topically applied medicaments. Serious toxicity can occur from the application of topical steroids, salicylic acid, neomycin, boric acid, aniline dyes, hexachloro­phene, and related antiseptics. The rate of transepidermal water loss through intact and non sweating skin of the newborn is high, indicating immaturity of the skin barrier function. Dehydration rapidly develops. Hypothermia develops rapidly in widespread skin rashes. During early weeks of life, the blood levels of some hormones are similar to that of the mother, e.g., androgens levels are high and these are the cause of neonatal acne. Scratching does not seem to develop until around 6 months of age.

Acne can be classified into neonatal acne, infantile acne, mid-childhood acne and prepubertal acne depending on the age of onset. There is limited literature available on acne in pediatric age group. This article provides an overview of clinical presentation and pathogenesis of acne in children and proposes therapeutic guidelines.

Acne occurs primarily in the first year of life and at puberty. Neonatal and infantile acne may reflect the relatively high androgens from the adrenal in girls and the adrenal and testes in boys characteristic of this age. Early in puberty, acne in boys and girls is primarily comedonal and midfacial. The best predictors of severe acne are early onset of comedones and serum levels of dehydroepiandrosterone sulfate. Early recognition and therapy of acne may prevent scarring and psychological stress.

Acne is a disease that can be seen in the first year of age, early childhood, prepubertal age and puberty. Neonatal acne is due mainly to considerable sebum excretion rate, and infantile acne because of high androgens of adrenal origin in girls and of adrenal and testes in boys. These pathogenic mechanisms are characteristic in these ages. Important factors like early onset of comedones and high serum levels of dehydroepiandrosterone sulfate are predictors of severe or long-standing acne in prepubertal age. Hereditary factors play an important role in acne. Neonatal, nodulocystic acne and conglobate acne has proven genetic influences. Postadolescent acne is related with a first-degree relative with the condition in 50% of the cases. Chromosomal abnormalities, HLA phenotypes, polymorphism of human cytochrome P-450 1A1 and MUC1 gene are involved in the pathogenesis of acne. Several other genes are being studied.

This special issue of the Clinics in Dermatology Journal, Pediatric Dermatology Part III, covers the management of common dermatologic problems in children. It is highlighted by the article from Lawrence Charles Parish and myself on the backgrounds, problems, and perspectives of management of common pediatric skin problems in developing countries. Wallach provided good information about the management of common benign neonatal diseases, which include neonatal acne, milia, miliaria, and toxicum neonatorum. Kurban and Al-Mahroos from Boston present a comprehensive chapter on the management of mastocytosis and another on sun protection. Schachner, Fulabella, and Bello give an overview on the management of epidermolysis bullosa, which Herane wrote a very nice chapter on vitiligo and leukoderma. Another chapter covered the treatment of cornification disorders in children, which is a challenging subject. Hypopigmentation in children is another challenge, and treatment is disappointing much of the time. The management of ichthyosis in infants and children is a continuing problem dealt with successfully by Rubeiz and Kibbi. Antihistamine and steroid use in pediatric dermatology is a very important topic that both dermatologists and pediatricians should recognize, as addressed in the chapter by Katsambas. The state-of-theart topic on pediatric cosmetic dermatology, is well executed by Lahti, Shabshi, Lewis, and Benedetto. Lastly the nutritional problems in children in developing countries is a major problem, and so its cutaneous aspect, was also included in this chapter. In his Foreword of the yearly issue of UNICEF’s The State of Health of the World’s Children 2002, Kofi A. Annan, Secretary-General of the United Nations, said

Background A type of neonatal cephalic pustulosis that is clinically similar to classic neonatal acne recently has been linked to Malassezia furfur infection. To correlate the mycological and clinical findings in neonates with cephalic pustulosis, we carried out a prospective case-control study in a neonatal unit from February to April 1997 using new techniques for classifying Malassezia species. Observations Nineteen patients with cephalic pustulosis and 19 controls younger than 45 days were studied among 161 consecutively hospitalized infants. Cultures from swabs and smears of pustules were obtained from patients, and swabs from healthy site-matched skin were obtained from controls. Three patients were excluded from the study because another cause of pustulosis was found. A blank sampling of pustules was obtained from 2 patients. Test results for 6 of 16 patients were positive for Malassezia sympodialis on contralateral nonpustular skin, and 4 of those patients also had positive cultures for M sympodialis . Cultures from 6 of 19 controls were positive (4 for M furfur and 2 for M sympodialis ). The prevalence of Malassezia species increased with age, and the severity of the pustulosis was correlated with the isolation of M sympodialis. Conclusion Our data suggest that M sympodialis triggers the severe form of common cephalic pustulosis in infants with this benign disorder.

Background: Papulopustular eruptions of the face in neonates are frequently referred to as neonatal acne or sebaceous miliaria. Our findings suggest that there is an association between this type of eruption and Malassezia furfur infection. Observations: Direct examination of pustule smears showed M fufur yeasts in eight of 13 cases involving neonates with erythema and papulopustules of the face, neck, and scalp (mean age at onset, 22 days [range, 7 to 30 days]). The pustules were predominantly neutrophilic. Treatment with 2% ketoconazole cream applied topically twice daily was effective in 1 week. Conclusion: Malassezia furfur is frequently associated with a common nonfollicular pustulosis of the newborn, probably improperly termed neonatal acne. (Arch Dermatol. 1996;132:190-193)

SUMMARY A baby with the fetal hydantoin syndrome was found to have acne vulgaris of the face. Hydantoin taken by epileptic women during pregnancy may cause neonatal acne in the offspring.

To assess skin colonization by Malassezia species in full-term healthy newborns, to investigate factors associated with colonization, and to look at acnelike cephalic pustulosis associated with this carriage.Samples were obtained from neonates and their mothers 0 to 5 days after birth and again 3 weeks later. Clinical patterns of common acnelike pustulosis were reported as mild (10 papulopustules), moderate (or =10 papulopustules), or absent. Direct examination and culture of sample. Identification of yeasts was based on microscopic and physiologic criteria.A maternity hospital and the pediatric dermatology unit of a university hospital.Consecutive series of 102 neonates and their mothers.Incidence of skin colonization and type of Malassezia species found in neonates and correlation with neonatal cephalic pustulosis (neonatal acne).At the first visit, 11 neonates and 36 mothers had cultures positive for Malassezia. Malassezia sympodialis and Malassezia globosa were preferentially cultured. At 3 weeks, 29 (52%) of 56 neonates and 18 (32%) of 56 mothers had cultures positive for only M sympodialis and M globosa. Breastfeeding was not associated with a higher prevalence of Malassezia carriage in neonates. Malassezia colonization was higher when pustulosis was more severe and M sympodialis was found in pustules.Malassezia colonization begins at birth and increases in the first weeks of life. A high prevalence of M sympodialis in neonates is noted from birth. Its association with neonatal acne is confirmed. Further investigation is needed to study the role of sebum secretion rate and quality in the neonatal period.

To the Editor.— Cases of infantile nodulocystic acne have been reported since 1926. 1-6 Hellier 4 divided acneiform eruptions of infancy into two groups. The first group included those patients in whom lesions developed during the first few weeks of life (neonatal acne, acne neonatorum, and grouped comedones of infants and children), while the second group consisted of those that developed lesions at the age of about a year or more. It was his experience that in the older group, lesions tended to be fewer and often took the form of cold abscesses. We describe a girl who developed nodulocystic acne at the age of 18 months and who was a member of a kindred with extensive steatocystoma multiplex. Report of a Case.— A 23-month-old girl was seen in January 1985. Her gestation and delivery were normal. She was well until 18 months of age, at which time she began