Saturday, 14 July 2012

Treatment of neonatal cephalic pustulosis


The neonatal or newborn period is the first 4 weeks of extrauterine life.



Patients with neonatal cephalic pustulosis (NCP) have been previously diagnosed as having neonatal acne. NCP is a pustular eruption arising on the face and/or scalp of neonates. Some believe that the two conditions are variants of the same process and actually it can be hard to distinguish between the two conditions at times. NCP lesions (comedonal lesions are not usually seen) typically appear around 2 weeks of age and usually resolve spontaneously in about 2 months. Infantile acne is much less common and usually presents later than neonatal acne/NCP at 3–6 months of age but has been reported as late as 16 months (such acne can be more severe and persistent).



It has been postulated that NCP develops in association with Malassezia species (though not all neonates with this clinical presentation have detectable Malassezia in the lesions). NCP might be related to an overgrowth of lipophilic yeasts at birth that results in an inflammatory reaction leading to monomorphic papules and pustules in predisposed neonates with more sebum production. At least some of the Malassezia-negative cases may have “genuine neonatal acne”, which is generally distinguished by the concurrent presence of comedones (when needed, patients are treated topically with benzoyl peroxide at the lowest strength possible to avoid irritation). In infants with inflammatory acne, oral erythromycin is used. In cases of erythromycin-resistant acne, oral isotretinoin can be given.
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Treatment is often not required for this self-limiting disorder. If the condition persists and/or is widespread and unsightly, topical ketoconazole 2% cream for 15 days helps to shorten the duration of lesions.


This page was last updated in December 2015.

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Main Works of Reference List (The first eight are my top favourites)

  • British National Formulary
  • British National Formulary for Children
  • Guidelines (BAD - BASHH - BHIVA - Uroweb)
  • Oxford Handbook of Genitourinary Medicine, HIV, and Sexual Health
  • Oxford Handbook of Medical Dermatology
  • Rook's Textbook of Dermatology
  • Simple Skin Surgery
  • Weedon's Skin Pathology
  • A Concise Atlas of Dermatopathology (P Mckee)
  • Ackerman's Resolving Quandaries in Dermatology, Pathology and Dermatopathology
  • Andrews' Diseases of the Skin
  • Andrology (Nieschlag E FRCP, Behre M and Nieschlag S)
  • Bailey and Love's Short Practice of Surgery
  • Davidson's Essentials of Medicine
  • Davidson's Principles and Practice of Medicine
  • Fitzpatrick's Colour Atlas and Synopsis of Clinical Dermatology (Klaus Wolff FRCP and Richard Allen Johnson)
  • Fitzpatrick’s Dermatology in General Medicine
  • Ganong's Review of Medical Physiology
  • Gray's Anatomy
  • Hamilton Bailey's Demonstrations of Physical Signs in Clinical Surgery
  • Hutchison's Clinical Methods
  • Lever's Histopathology of the Skin
  • Lever's Histopathology of the Skin (Atlas and Synopsis)
  • Macleod's Clinical Examination
  • Martindale: The Complete Drug Reference
  • Oxford Handbook of Clinical Examination and Practical Skills
  • Oxford Textbook of Medicine
  • Practical Dermatopathology (R Rapini)
  • Sexually Transmitted Diseases (Holmes K et al)
  • Statistics in Clinical Practice (D Coggon FRCP)
  • Stockley's Drug Interactions
  • Treatment of Skin Disease: Comprehensive Therapeutic Strategies
  • Yen & Jaffe's Reproductive Endocrinology