In our third installment covering infant skin issues, we’ll be discussing milia and baby acne. Unlike some of the skin conditions we’ve covered, milia and baby acne are not rashes.

Milia are tiny white bumps that appear on a baby’s nose, chin, cheeks, or eyelids. These bumps tend to appear in groups or clusters of small white or yellowish bumps. A single milium can range from less than 1 millimeter up to 3 millimeters in size. Although they are very common in newborn babies, they can appear at any age.

There are two basic types of milia:

• Primary: the most common form of milia, especially on babies, appears on healthy skin. They frequently occur on the eyelids, forehead, cheeks, or genitals.
• Secondary: also known as traumatic milia, this type appears on skin that has acne, infection, or is in otherwise damaged condition. Secondary milia often appear on skin that has been damaged by burns, rashes, blisters, reaction to a topical cream/ointment, or even excessive exposure to sunlight. The milia develop as the skin heals. In this instance, it is more common to occur on older children or adults than on newborns.

What Causes Milia?

Milia are caused by keratin from dead skin cells, accumulating just under the surface of the skin. In essence, they are tiny, benign cysts caused by a buildup of skin flakes. However, they do not require removal like some other types of cysts.

Milia Treatment

Milia doesn’t require treatment at all unless the bumps become red or inflamed, or if the area develops a crusty appearance. If you see the area developing redness, swelling, or forming crust around the milia, call our office for an appointment. It is possible that an infection or underlying skin condition could be causing the milia.

Milia do not cause pain or itching for your baby. Attempting to squeeze milia bumps like a pimple can cause the skin to become sore or even infected. Untreated infection can result in scarring, so it is best to leave milia bumps be. You will simply want to keep your baby’s skin clean and avoid any irritating lotions or heavily scented products on the area that could cause irritation.

While milia cannot be prevented, the bumps will usually clear on their own in a few weeks to a month.

Acne? On Babies?

Baby acne is also known as “neonatal acne.” It is not a true type of acne and is only temporary in duration, usually lasting 1 to 3 months. It is believed to be caused by an inflammatory reaction to yeast on the skin. The condition is very common, occurring in more than 20% of healthy newborns.

Baby acne often presents around two weeks of age, with tiny bumps and pustules on a baby’s forehead, cheeks, eyelids, or chin. These small pustules can extend into the scalp, as well. Occasionally, the pustules will appear on the neck and upper trunk. Unlike true acne, baby acne does not consist of any blackheads or whitehead pustules.

Baby Acne Versus Infantile Acne

Baby acne differs from infantile acne. Infantile acne is much less common and can present with open comedones or blackheads, while baby acne does not. Cysts or nodules are also sometimes seen with infantile acne and the condition can result in scarring without treatment. Infantile acne can persist until the baby is two years old.

What Causes Baby Acne?

While the cause of baby acne is unknown, some studies link the condition to maternal or infant hormones, while others believe it to be caused by an inflammatory reaction to yeast on the skin.

Baby Acne Treatment

Baby acne will usually clear without medical treatment. If your baby’s acne does not resolve on its own within 3 months, contact our office for an appointment. If treatment is necessary, an antifungal cream such as ketoconazole or a low-potency topical steroid such as hydrocortisone may be prescribed. Also, if you see other symptoms such as a fever, irritability, decreased appetite, or other skin conditions developing, we would recommend an appointment with our office as soon as possible.