Dermatology Book

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Transient Neonatal Pustular Melanosis

Aka: Transient Neonatal Pustular Melanosis, Pustular Melanosis, Transient Neonatal Pustulosis
  1. See Also
    1. Newborn Skin Exam
  2. Definitions
    1. Transient Neonatal Pustular Melanosis
      1. Newborn Rash with vessicles and Pustules most common with dark complexion
  3. Epidemiology: Incidence by ethnicity
    1. Black Infants: 4.4%
    2. White Infants: 0.2%
  4. Pathophysiology
    1. Benign condition
    2. Resolves spontaneously in first 3 months of life
  5. Signs
    1. Size: 2 to 4 mm
    2. Initial: Milky fluid filled Pustule
    3. Later: Hyperpigmented Macule with scale (collarette appearance) after Pustule ruptures
    4. No surrounding erythema (contrast with Erythema Toxicum Neonatorum)
    5. Distribution
      1. Especially on chin, neck, trunk and buttock
      2. Can be on palms and soles
  6. 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)
  7. Labs
    1. Pustules contain Neutrophils on Gram Stain or wright stain
    2. Culture Negative
  8. Management
    1. Reassurance for parents
  9. References
    1. Claudius and Behar in Herbert (2020) EM:Rap 20(8): 5-7

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