[4] The main cause is not known for certain but it may be caused by maternal androgens transferred from the mother to the newborn from the placenta and androgens produced by the fetal adrenal gland and neonatal testicles that stimulate sebaceous glands to increase production of sebum.

[7] It is believed that maternal androgens passed to the infant through the placenta has a role in stimulating sebaceous glands leading to increased sebum production that causes comedone formation.

[7][5] The role of genetics is unclear but a positive family history supports association with neonatal acne.

[9] Other causes of acneiform eruptions such as those induced by the use of topical products like creams, ointments and shampoos on the skin are often ruled out before diagnosis.

[7] Maternal medications like lithium and high dose corticosteroids may also induce formulation of pustules in newborns and can be assessed with a thorough family history.

[7] BPO is a lipophilic agent that penetrates into sebaceous glands and generates reactive oxygen species that kill P.

[6] The most common side effects of topical antibiotics are stinging, burning and redness at the site of application.

[5] Some experts suggest the use of topical ketoconazole in newborns with more pustular neonatal acne as there is evidence it shortens duration of lesions.