II. Epidemiology

  1. Incidence: 30-70% of all infants
  2. More common in term infants (birth weight >2500 grams)
  3. Most common pustular dermatitis in newborns

III. Symptoms

  1. Newborn Rash with flea-bitten appearance
  2. Occurs 24 hours to 2 weeks after birth
    1. Typically onset in first 4 days of life, but not present at birth
  3. Lesions fade in 1 week (may recur in first few weeks of life)
    1. Typically resolves after 4 days

IV. Signs

  1. Flea-Bitten Appearance
    1. Small white Pustules on red base
  2. Characteristics
    1. Follicular, yellowish-hued, papulovesicular lesions
    2. Starts as Macule or Papule
    3. Develops Pustules later
    4. Lesions sorrounded by irregular erythema
  3. Size: lesions are 1 to 3 mm in diameter
  4. Distribution
    1. Involved areas: Face, trunk, and proximal arms, and legs
    2. Spared areas: palms and soles
  5. No associated organ involvement
    1. Contrast with Neonatal HSV (e.g. Hepatomegaly)

V. Labs

  1. Vesicles contain Eosinophils on Gram Stain or wright stain
  2. Negative culture
  3. Complete Blood Count
    1. Differential with increased Eosinophils

VI. Differential Diagnosis

VII. Associated Conditions

  1. Transient Neonatal Pustular Melanosis
    1. Similar condition seen in children with darker complexion
    2. Pustules without surrounding erythema

VIII. Management

  1. No management needed for this benign dermatitis
  2. Resolves spontaneously

IX. References

  1. Claudius and Behar in Herbert (2020) EM:Rap 20(8): 5-7
  2. Liu (2005) Dermatology 210:269-72 [PubMed]

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