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Transient Neonatal Pustular Melanosis Clinical Presentation

  • Author: Jennifer Sorrell, MD; Chief Editor: William D James, MD  more...
 
Updated: May 16, 2016
 

History

Often, only pigmented macules are present at birth, in which case the pustular phase may have occurred in utero. Skin findings can be correlated with gestational age at birth. Post-term infants are more likely to have the late finding of pigmented macules. No systemic symptoms are associated with the skin lesions of transient neonatal pustular melanosis.[4, 10]

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Physical

Transient neonatal pustular melanosis is characterized by vesicles, superficial pustules, and pigmented macules.

Because of the fragile nature of the superficial pustules, most are broken during the initial drying or cleansing of the newborn. Intact lesions may remain in more protected areas such as beneath the chin, in the axillae, or in the groin. The vesicles and pustules may desquamate during the neonate's first bath, leaving characteristic white collarettes of scale and brown macules. The vesicopustules resolve within 24-48 hours.[6] The hyperpigmented macules usually fade within 3-4 weeks, although full resolution may take several months.[9] Note the image below.

Ruptured pustules and vesicles with remaining char Ruptured pustules and vesicles with remaining characteristic collarette of scale and brown hyperpigmented macules. Courtesy of Anthony J. Mancini, MD.

Depending on the time of the examination in the neonatal period, the vesicles, pustules, and/or pigmented macules may be found predominantly on the chin, neck, or forehead; behind the ears; or on the trunk, palms, and soles.[7]

The lesions are 2-10 mm in diameter. Vesicles and pustules are usually 2-4 mm and are often filled with milky fluid. These lesions lack surrounding erythema.[5, 9]

No systemic signs or symptoms are associated with the skin eruptions.

Papules are not seen in transient neonatal pustular melanosis, but they may be seen in neonates with erythema toxicum neonatorium, acne neonatorum, or miliaria. The vesiculopustular lesions may be similar to lesions seen in acropustulosis. Acropustulosis is also more common in African American infants, but it has a male predominance and pruritic lesions cluster on the palms and soles.[8]

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Causes

The etiology of transient neonatal pustular melanosis is unknown. No familial predisposition has been identified for transient neonatal pustular melanosis.

Increased frequency of placental squamous metaplasia has been reported in the mothers of some of these infants, although this relationship has not been demonstrated in any large trial.[11]

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Contributor Information and Disclosures
Author

Jennifer Sorrell, MD Resident Physician, Department of Dermatology, Northwestern University,The Feinberg School of Medicine

Jennifer Sorrell, MD is a member of the following medical societies: American Academy of Dermatology, Society for Pediatric Dermatology, Chicago Dermatological Society

Disclosure: Nothing to disclose.

Coauthor(s)

Anne Elizabeth Laumann, MBChB, MRCP(UK), FAAD Professor of Dermatology, Chief of General Dermatology, Director of the Collagen Vascular Disorders Clinic, Northwestern University, The Feinberg School of Medicine

Anne Elizabeth Laumann, MBChB, MRCP(UK), FAAD is a member of the following medical societies: American Academy of Dermatology, Association of Professors of Dermatology, British Association of Dermatologists, Chicago Dermatological Society, Chicago Medical Society, Illinois Dermatological Society, Illinois State Medical Society, Medical Dermatology Society, Society for Investigative Dermatology, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Van Perry, MD Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas School of Medicine at San Antonio

Van Perry, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Drugs & Diseases gratefully acknowledge the contributions of previous author, Britt A Durham, MD, to the development and writing of this article.

References
  1. Taieb A, Boralevi F. Hypermelanoses of the newborn and of the infant. Dermatol Clin. 2007 Jul. 25(3):327-36, viii. [Medline].

  2. van Emmen E, Roord ST, Brouwer AF, Kuiters GR, Bekhof J. [Pustular and vesicular skin eruptions in newborns]. Ned Tijdschr Geneeskd. 2007 Feb 3. 151(5):277-83. [Medline].

  3. Van Praag MC, Van Rooij RW, Folkers E, Spritzer R, Menke HE, Oranje AP. Diagnosis and treatment of pustular disorders in the neonate. Pediatr Dermatol. 1997 Mar-Apr. 14(2):131-43. [Medline].

  4. Wyre HW Jr, Murphy MO. Transient neonatal pustular melanosis. Arch Dermatol. 1979 Apr. 115(4):458. [Medline].

  5. Wagner A. Distinguishing vesicular and pustular disorders in the neonate. Curr Opin Pediatr. 1997 Aug. 9(4):396-405. [Medline].

  6. Ramamurthy RS, Reveri M, Esterly NB, Fretzin DF, Pildes RS. Transient neonatal pustular melanosis. J Pediatr. 1976 May. 88(5):831-5. [Medline].

  7. Dinulos JG, Graham EA. Influence of culture and pigment on skin conditions in children. Pediatr Rev. 1998 Aug. 19(8):268-75. [Medline].

  8. Mengesha YM, Bennett ML. Pustular skin disorders: diagnosis and treatment. Am J Clin Dermatol. 2002. 3(6):389-400. [Medline].

  9. O'Connor NR, McLaughlin MR, Ham P. Newborn skin: Part I. Common rashes. Am Fam Physician. 2008 Jan 1. 77(1):47-52. [Medline].

  10. Chia PS, Leung C, Hsu YL, Lo CY. An infant with transient neonatal pustular melanosis presenting as pustules. Pediatr Neonatol. 2010 Dec. 51(6):356-8. [Medline].

  11. Auster B. Transient neonatal pustular melanosis. Cutis. 1978. 22:327-328.

  12. Wu, H, Brandling-Bennett, HA, Harrist, TJ. Noninfectious vesiculobullous and vesiculopustular diseases. Elder D, Elenitsasis R, Jaworsky C, Johnson Jr B. Lever's Histopathology. 10th. Philadelphia, Pa: Lippincott-Raven; 2004.

 
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Ruptured pustules and vesicles with remaining characteristic collarette of scale and brown hyperpigmented macules. Courtesy of Anthony J. Mancini, MD.
 
 
 
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