II. Epidemiology
- Incidence: 30-70% of all infants
- More common in term infants (birth weight >2500 grams)
- Most common pustular dermatitis in newborns
III. Symptoms
- Newborn Rash with flea-bitten appearance
- Occurs 24 hours to 2 weeks after birth
- Typically onset in first 4 days of life, but not present at birth
- Lesions fade in 1 week (may recur in first few weeks of life)
- Typically resolves after 4 days
IV. Signs
-
Flea-Bitten Appearance
- Small white Pustules on red base
- Characteristics
- Size: Lesions are 1 to 3 mm in diameter
- Lesions are NOT grouped
- Contrast the grouped lesions in Neonatal HSV
- Distribution
- Involved areas: Face, trunk, and proximal arms, and legs
- Spared areas: Palms and soles
- No associated organ involvement
- Contrast with Neonatal HSV (e.g. Hepatomegaly)
V. Labs
- Vesicles contain Eosinophils on Gram Stain or wright stain
- Negative culture
-
Complete Blood Count
- Differential with increased Eosinophils
VI. Differential Diagnosis
VII. Associated Conditions
-
Transient Neonatal Pustular Melanosis
- Similar condition seen in children with darker complexion
- Pustules without surrounding erythema
VIII. Management
- No management needed for this benign dermatitis
- Resolves spontaneously in 1 to 2 weeks without scarring
IX. References
- Claudius and Behar in Herbert (2020) EM:Rap 20(8): 5-7
- Liu (2005) Dermatology 210:269-72 [PubMed]
- Snyder (2024) Am Fam Physician 109(3): 212-6 [PubMed]