Rashes are extremely common in babies—especially newborns—and they’re often harmless and fleeting. That said, there are some types of infant rashes that may become concerning and could benefit from treatment to help restore your little one’s velvety skin. Two very common types of infant skin lesions such as these are baby acne and baby eczema—and it can be difficult to differentiate between the two. To help you better understand and spot the difference between baby acne and eczema, we tapped the experts. Ahead, learn all about the hallmark characteristics of each rash, as well as what causes them and the treatment options available to you.
What Is Baby Acne?
When you think of acne, you may automatically associate it with the plight of hormonal teenagers. But, in actuality, it can affect people of nearly any age—babies included. Around 20% of infants have baby acne (a.k.a. “neonatal acne”) either from birth or in their first six weeks of life, with baby boys experiencing it much more frequently than girls. “Baby acne is a pustular rash, typically on the head and neck of newborns,” says Ann Masciantonio, MD, MS, FAAP, and Chief of Ambulatory Pediatrics at ChristianaCare Pediatric Associates in Newark, Delaware. “It typically consists of inflammatory, red papules and pustules, the absence of blackheads, and is typically distributed on the face and sometimes the scalp.” In other words, baby acne looks like, well, pimples on and around your little one’s face. That said, baby acne can also show up in other places too, like on their back or chest. Unlike acne that develops when you’re a teenager or adult, baby acne is associated with shifting factors before they’re born, and immediately after, and as they cruise through their first year of life. “Baby acne occurs when the pores on a baby’s face become clogged under the influence of mom’s hormones in the womb,” explains Gibran Shaikh, MD, a board-certified dermatologist at The Dermatology Specialists in NYC and founder of MySkinofColor.com. “It develops on the cheeks, nose, and forehead of a newborn, [usually] resolving completely a few months after birth as those levels fall.” This prenatal development of acne is due to your baby’s contact with hormones in your body known as “androgens,” which stimulate your little one’s skin to produce excess, pore-clogging oil, making them more prone to acne. After birth, your infant’s own adrenal glands kick in, producing their own androgens—even moreso in boys. This new cascade of androgens can then trigger another increase in oil production and an even greater susceptibility to acne. Fortunately, with time, the super-charged influx of hormones typically subsides. Between about 6 and 12 months of age, your baby’s adrenal glands begin to shrink, gradually slowing the production of androgens. As those levels even out, so too does the overproduction of skin oil, therefore reducing the occurrence of acne. Of course, if you’re ever concerned about the severity—or longevity—of your baby’s acne, it’s always best to speak to their pediatrician or a pediatric dermatologist. Also, keep in mind that if your infant was affected by baby acne, their chances of getting acne as a teenager are higher, and it may be more challenging to treat. So, it might be wise to start your teenage acne education early, so you’re prepared if or when the time comes.
What is Baby Eczema?
On the other hand, baby eczema, otherwise known as “atopic dermatitis,” is even more common than baby acne, with about 60% of infants developing it in their first year. “The affected skin is usually dry, and scaly or flaky,” describes Justin M. Skripak, MD, a board-certified allergist and immunologist at ENT and Allergy Associates in Paramus, New Jersey. “It usually appears in the first few months of life on the face and scalp.” Although these raised, red bumps typically pop up on or before the 3 month mark, they can also arise between 1 and 6 months, or up to 2 years old. “If eczema persists or develops later in the first year of life, it often affects the arms and legs,” he says. And baby eczema, regardless of the location, has the potential to become bothersome to your infant, causing itchy skin that can range from mild to severe. Along with rough patches of skin, the itchiness can cause your baby’s skin to become red, raw, or even oozy. And there are a handful of potential triggers, which can initially be challenging to narrow down. This can include everything from pollen, animal dander, dry air, and scratchy, rough fabrics such as wool, to food allergies and intolerances. In fact, among babies and young kids with severe eczema, food allergies are a contributing factor in 30% of cases, with eggs and cow’s milk being the biggest culprits. “Baby eczema is a chronic, long-term skin condition that presents with red, itchy patches, most commonly on the face, arms, and legs,” Dr. Shaikh tells us. “There is usually a family history, so it’s caused by a combination of genes and environmental exposures, like pollen, dander, and dust mites, leading to an allergic reaction.” Although there’s no cure for it, he assures us that baby eczema often gets better in later childhood or adolescence. It’s not always the case, but some children may outgrow the frequency and severity of flare-ups, as well as benefit from targeted skincare products, medications, and trigger-avoidance tactics that can help along the way. Overall, identifying and treating baby eczema can be a bit more difficult than the typical wait-it-out-and-see approach to baby acne. And, as if that weren’t complicated enough, although it’s most strongly associated with allergies, those too, are not always the case. “Babies with eczema are more likely to have allergies,” Dr. Skripak confirms, “but many have no allergies.” Case in point: If you suspect your infant has eczema, always speak to your child’s pediatrician, a dermatologist, or an allergist for a professional diagnosis.
How To Tell the Difference Between Baby Acne and Baby Eczema
While baby acne and eczema are caused by a vastly different set of triggers, it’s not always easy to differentiate between the two. “Often, they both occur at the same time and in the same locations,” Dr. Masciantonio shares. “Eczema can appear red and bumpy, and acne does not always have a pustule, so the two are often confused or present simultaneously.” Although they may look similar at first glance, there are some key giveaways that come with each condition. “While both can have small red bumps, eczema more often causes patches,” explains Dr. Skripak. “The patches typically are dry and scaly.” Plus, one of the most telling differentiators is the itch factor. “You are likely to see your baby scratching eczema, but not acne.” So, if you have an itchy infant on your hands, pimples alone are likely not the problem. Then, there’s the timing and resilience of the rash. Baby acne tends to develop before your little one’s first six weeks, and rarely leaves scars (if it shows up after that, it’s known as “infantile acne,” which can be more severe and runs the risk of scarring). Conversely, baby eczema typically arises much later, anywhere from 6 months to their first few years. However, only a doctor can accurately make the call one way or the other, so resist the urge to self-diagnose your infant and, instead, reach out to the pros.
Treatment for Baby Acne
Baby acne is most likely to occur on your infant’s cheeks and nose, but, as we covered, it can also pop up on the rest of their face, such as their forehead and chin, as well as on their scalp, neck, chest, and back. Usually, it’s no cause for concern and will go away on its own, rarely leaving scars. “Baby acne doesn’t need to be treated, because it resolves by itself as [excess] hormones leave the baby’s system,” Dr. Shaikh assures us. That said, there is one caveat: “If there is any confusion or it is worsening, it’s best to see a board-certified dermatologist who can confirm the diagnosis and make sure it doesn’t reflect an internal disease.” There are other skin conditions, health issues, and product-related skincare reactions that, in addition to baby eczema, can mimic the appearance of baby acne. So, before you go completely laissez-faire, it’s best to rule out anything potentially more serious. If you’re not the type to wait for a baby acne breakout to clear up on its own, there are simple ways you may be able to help it along. “The majority of baby acne is mild, and can be treated by daily cleansing with soap and water while avoiding creams, emollients, and oils,” advises Dr. Masciantonio. Just as you would gently wash your own breakouts and avoid heavy products, the same practices can be applied to your little one’s.
Treatment for Baby Eczema
Treating baby eczema is a little less straightforward, since there can be multiple triggers from genetic, environmental, and dietary origins. And every infant’s situation is unique, so it’s usually best to take a multi-pronged approach. This can include seeking the help of your child’s pediatrician, a dermatologist, and an allergist. You might also see a pediatric nutritionist, if food allergies or intolerances are suspect. Other parents swear by alternative therapies for eczema performed by acupuncturists and naturopaths, whose efficacy with treating eczema are just recently being studied and showing promising initial results. Below are some traditional go-tos for treatment.
Early Intervention
Above all, seek treatment early on as soon as you notice signs of baby eczema. Doing so can help halt it in its tracks and prevent it from becoming more difficult to treat later on. This is also important because babies with eczema are more prone to skin infections, which can lead to additional problems down the road.
Topicals
“Baby eczema is treated with moisturizers like Aquaphor or Vanicream—the thicker the better,” Dr. Shaikh shares. “I recommend a ‘soak and smear,’ which is a quick, lukewarm bath, pat dry, followed by head-to-toe application of moisturizer, with a focus on dry areas.” In severe cases, he advocates heading to a dermatologist, who may opt to prescribe topical anti-inflammatory medications, like hydrocortisone, to help soothe the skin, reduce itchiness, and help your infant’s skin heal. Along the same lines, it’s also important to be sure the products you’re using aren’t irritating your baby’s skin further. Dr. Skripak cautions to stay away from moisturizing creams or ointments that have dyes or fragrances, and to be sure to apply appropriate moisturizers multiple times a day.
Proper Dress and Grooming
In addition to steering clear of potentially irritating ingredients, Dr. Skripak has another tip: “Dress your baby in cotton clothing, which is cooler and less irritating than other fabrics.” He also recommends keeping your baby’s nails short, so they’re less likely to scratch itchy patches and damage their skin. So, pamper your baby with a teeny mani-pedi—and help protect them in the process.
Identify and Eliminate Triggers
The key to reducing baby eczema flare-ups is knowing what’s causing them in the first place. It could be something as simple as dried saliva on your baby’s face that’s to blame for irritating their skin, which could be treated by applying a thin layer of plain petroleum around their mouth before naps and feedings. Other triggers could be sweat, the aforementioned pet dander, pollen, or dry air, as well as certain clothing and product ingredients. If you suspect something specific, try removing or replacing it in your baby’s environment and see if it helps ease their symptoms.
What Other Rashes Look Like Baby Acne or Baby Eczema?
There are numerous other skin conditions that could be causing a rash that’s easily mistaken for baby acne or baby eczema. “Rashes are common during infancy, and most are harmless and self-limited,” explains Dr. Masciantonio. “Forms of eczema are by far the most common rash during infancy, but other causes are well-known, including viruses (like hand, foot, and mouth disease), bacteria (streptococcus, staphylococcus), contact (chemical, plant, animal), diaper (yeast), food, and allergens (seasonal/environmental).” That’s precisely why the best course of action is always to consult your healthcare professional who can make an accurate call and effective treatment plan. Without a pro to diagnose, the possibilities can be seemingly endless. “Eczema is occasionally confused for fungal infections, seborrheic dermatitis (cradle cap/diaper rash), and psoriasis,” elaborates Dr. Shaikh. Other rashes that could be easily misidentified by a layman are less severe, albeit similarly bothersome. “Baby acne can be confused with heat rash (miliaria) and a common condition called neonatal cephalic pustulosis, which literally translates to: ‘Pus bumps on the head of newborns,’” he tells us—noting that neither are dangerous, and both should resolve themselves by 6 months of age, without leaving lasting marks. Still, it’s usually best to take the wait-and-see route only when your baby is under the supervision of a healthcare professional. And always be on the lookout for changes in your baby’s level of alertness, activity, and eating habits, as well as if a fever develops, which could indicate an infection.
A Word From Verywell
Seeing your baby’s skin mottled with red bumps or splotches can be upsetting and stressful to help alleviate. But with a proper diagnosis from a doctor, you’ll be able to know one way or another whether they have baby acne, baby eczema, or one of the many other types of rashes that affect infants. Just remember, it’s extremely common for infants to get rashes, and, usually, they aren’t any cause for concern. And knowing what to do—and not to do—to help alleviate their symptoms the right way can ultimately bring relief for you both.
