II. Definitions

  1. Transient Neonatal Pustular Melanosis
    1. Newborn Rash with vessicles and Pustules most common with dark complexion

III. Epidemiology: Incidence by ethnicity

  1. Black Infants: 4.4%
  2. White Infants: 0.2%

IV. Pathophysiology

  1. Benign condition affecting skin containing higher levels of Melanin
  2. Resolves spontaneously in first 3 months of life

V. Signs

  1. Size: 2 to 4 mm
  2. Pustular rash present at birth
    1. Initial: Milky fluid filled Pustule
    2. Next: Pustule ruptures
      1. Leaves a hyperpigmented Macule with scale (collarette appearance)
      2. Hyperpigmentation may persist for weeks to months before fading
    3. No surrounding erythema (contrast with Erythema Toxicum Neonatorum)
  3. Distribution
    1. Most common on the chin and neck, but also present on the forehead and behind the ears
    2. Also involves the trunk and buttocks
    3. Can be on palms and soles

VI. Differential Diagnosis

  1. See Neonatal Pustules and Vessicles
  2. Erythema Toxicum Neonatorum variant
    1. Contrast with no surrounding erythema in Melanosis
  3. Infectious Pustules (contrast with the uniquely pigmented Macule in Melanosis)

VII. Labs

  1. Pustules contain Neutrophils on Gram Stain or wright stain
  2. Culture Negative

VIII. Management

  1. Reassurance for parents

IX. References

  1. Claudius and Behar in Herbert (2020) EM:Rap 20(8): 5-7
  2. Snyder (2024) Am Fam Physician 109(3): 212-6 [PubMed]

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