Newborn Acne and Baby Skin Rashes

Start here, because this is the part that matters

Almost everything on newborn skin in the first weeks is normal and temporary. But one rash is not, and it is worth knowing before you read anything else.

The NHS adds a point that gets missed: on brown and black skin these changes are often easier to see on the soles of the feet, palms, lips, tongue and inside the eyelids. And it warns that a child can be seriously unwell without a high temperature, so a normal thermometer reading is not reassurance on its own.

Baby acne — what it is and what to do

The AAP describes baby acne as "pimples that break out on the face, usually during the third to fifth week". Its explanation has changed: doctors once attributed it to maternal hormones stimulating the baby's oil glands, but the AAP now says it "may be a normal response to bacteria and yeast on the skin, and it has been renamed neonatal cephalic pustulosis."

The treatment is almost nothing. The AAP's advice: "washing the face gently once a day with a mild baby soap is sufficient. The rash usually resolves on its own in a few weeks." In severe cases a paediatrician may prescribe a face cream. The AAP also notes that drops of breast milk applied to the rash may help.

What to avoid: heavy oils and ointments on the affected skin, and any adult acne product. The HSE's advice on newborn skin generally is to use plain water for the first four weeks or so, because "the chemicals and fragrances found in many baby skincare and bath products can irritate your baby's skin."

Milia — the white spots that are not acne

Milia are a different thing that gets called baby acne constantly. Raising Children Network describes them as "tiny white bumps that sometimes come up on babies' faces soon after birth", caused by sweat glands getting blocked because they are not yet fully developed. They appear mostly on the nose and cheeks, are usually under 1 mm across (occasionally up to 3 mm), and "don't hurt or itch."

The HSE calls them milia or "milk spots" and says the same thing: they do not need treatment and disappear on their own. Raising Children Network is explicit that you should not try to burst them — they leave no scars if left alone — and that gentle daily face washing is the only useful measure.

See a GP if you notice a coloured rash or crusting around the milia, which is a different problem.

The other normal newborn skin findings

The HSE's page on what newborns look like is the most useful single list of things parents worry about unnecessarily:

• Erythema toxicum. "Some newborns have a red rash on their chest and back. This is known as erythema toxicum. It disappears after a few days."
• Mottling. "A lacy pattern of small reddish and pale areas on the skin. It is very common. It is due to normal, varied blood circulation at the skin's surface." Note the distinction from the mottled, ashen look that NICE flags as a red flag — that one comes with an unwell baby, not a well one.
• Dark red or purple appearance at birth, fading over a few days.
• Vernix, the white greasy coating, which absorbs into the skin during the first week and acts as a natural moisturiser.
• Dry, scaly skin, especially in babies born after their due date. "This does not need treatment. It will get better over time."
• Lanugo, soft downy body hair, which goes away on its own.

The AAP adds that a newborn's hands and feet may look colder and bluer than the rest of the body, because the blood vessels there are sensitive to temperature. Move the limbs and the colour should return quickly. What should always look pinkish or reddish is the mouth, lips and tongue — persistently blue skin is a different matter and needs immediate attention.

Birthmarks

The AAP splits birthmarks into vascular (extra blood vessels) and pigmented (extra colour), and says both types "are usually harmless, and some go away on their own." Two are worth knowing about:

• Nevus simplex — flat pink or red marks on the eyelids, forehead, back of the neck or between the eyebrows, known as salmon patches, stork bites or angel kisses. The AAP says up to 80% of babies are born with one and they usually go by the toddler years.
• Infantile haemangiomas — raised red or bluish growths found in up to 5% of infants, usually appearing in the first few weeks. These are the one type where timing matters: the AAP notes they grow most quickly in the first 5 to 7 weeks, and that treatments for problem haemangiomas "usually work best when started shortly after these birthmarks form — generally by around 1 month age." So mention it early rather than waiting.

What actually helps newborn skin

• Plain water for the first four weeks or so (HSE), then an emollient on dry patches if needed. If your baby was premature, the HSE advises waiting at least six weeks before using any products.
• Fragrance-free, dye-free, alcohol-free products if you use anything at all. Read the label rather than the marketing.
• No shampoo needed for most young babies; a soft brush or comb removes flakes.
• Biological washing powder is fine. The HSE states there is "no evidence that these irritate baby skin" — worth knowing before you buy a special detergent.

When to call

Ask for an urgent GP appointment or ring your out-of-hours line if your baby:

• Has a rash you are worried about and you are not sure what to do.
• Is under 3 months old and has a temperature of 38C (100.4F) or higher.
• Feels hotter than usual on their back or chest, feels sweaty, or is shivering.

See a GP non-urgently if a rash is spreading, weeping, crusting, blistering or smells; if the skin around it looks swollen; or if your baby seems bothered by it. The HSE's standing advice is to "always get skin rashes checked by your GP, particularly if your baby is unwell." Baby acne and milia do not make a baby unwell. If yours seems unwell, the rash is not the reason to relax.