Dermatology Book

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Transient Neonatal Pustular Melanosis

Aka: Transient Neonatal Pustular Melanosis, Pustular Melanosis
  1. See Also
    1. Newborn Skin Exam
  2. Definition
    1. Newborn Rash with vessicles and Pustules most common with black skin
  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 (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

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