Transient Neonatal Pustular Melanosis

This benign but impressive neonatal eruption progresses through several stages, beginning with pustules that quickly rupture and leave flat macules with collarettes of scale, as shown here. The pustules may rupture in utero, and the neonate may present at birth with the macules, as was the case in this baby boy. The macules are variously hyperpigmented and resolve over several days, although return of normal pigmentation may take a few months in some infants. The condition can be seen in all races but is somewhat more common in African Americans.

The lesions can occur anywhere but have a predilection for the chin, chest, trunk, and buttocks. The cause is unknown. The differential diagnosis for lesions in the pustular stage can include miliaria rubra, toxic erythema neonatorum, and infantile acne. It can also include more serious conditions, such as neonatal syphilis, neonatal candidiasis, and herpes simplex infection. The diagnosis is usually made by observing the evolution of the eruption and by the lack of systemic symptoms in an otherwise healthy neonate.

References:

FOR MORE INFORMATION:

•Â Paige DG, Gennery AR, Cant AJ. The neonate. In: Burns T, Breathnach S,Cox S, Griffiths C, eds.

Rook’s Textbook of Dermatology.

Vol 1. 8th ed. Oxford,UK: Wiley-Blackwell; 2010:17-8–9.

•Â Odom RB, James WD, Berger TG.

Andrew’s Diseases of the Skin: ClinicalDermatology.

9th ed. Philadelphia: WB Saunders; 2000:1061.