eMedicine Specialties > Dermatology > Pediatric Diseases

Transient Neonatal Pustular Melanosis: Differential Diagnoses & Workup

Author: Britt A Durham, MD, Co-Director of Risk Management, Assistant Professor, Department of Emergency Medicine, King-Drew Trauma Center and University of California at Los Angeles
Coauthor(s): Anne Laumann, MB, BCh, MRCP, FAAD, Associate Professor, Department of Dermatology, Feinberg School of Medicine, Northwestern University
Contributor Information and Disclosures

Updated: Sep 6, 2007

Differential Diagnoses

Acropustulosis of Infancy
Mongolian Spot
Erythema Toxicum Neonatorum
Syphilis
Herpes Simplex
Milia
Miliaria

Other Problems to Be Considered

Acne neonatorum
Congenital candidiasis
Impetigo neonatorum
Erythema toxicum
Staphylococcal infection
Ofuji syndrome
Neonatal varicella
Mongolian spots: These are bluish-black macular patches on the back and lumbosacral area; they are more common in dark-skinned babies than in light-skinned babies.

Workup

Laboratory Studies

  • The diagnosis is usually made at clinical examination.
  • A Tzanck smear may be performed. With a cellular stain (eg, Wright-Giemsa stain), a Tzanck smear reveals a predominance of neutrophils without evidence of bacteria, yeast, or viropathic changes.
  • Gram stain preparations for bacteria are negative.
  • Blood and skin culture results are negative.

Histologic Findings

Vesicles and pustules show intracorneal and subcorneal collections of neutrophils with some eosinophils and, occasionally, fragmented hairs. The dermis has an infiltrate of neutrophils and scattered eosinophils. The brown macules show epidermal basal cell melanosis.

More on Transient Neonatal Pustular Melanosis

Overview: Transient Neonatal Pustular Melanosis
Differential Diagnoses & Workup: Transient Neonatal Pustular Melanosis
Treatment & Medication: Transient Neonatal Pustular Melanosis
Follow-up: Transient Neonatal Pustular Melanosis
References
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References

  1. Cohen L, Skopicki D, Harrist T, Clark Jr W. Noninfectious vesiculobullous and vesiculopustular diseases. In: Elder D, Elenitsasis R, Jaworsky C, Johnson Jr B, eds. Lever's Histopathology. 8th ed. Philadelphia, Pa: Lippincott-Raven; 1997:237.

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

  3. Ferrándiz C, Coroleu W, Ribera M, Lorenzo JC, Natal A. Sterile transient neonatal pustulosis is a precocious form of erythema toxicum neonatorum. Dermatology. 1992;185(1):18-22. [Medline].

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

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

  6. St John EB. Neonatal Pustular Melanosis. eMedicine from WebMD [serial online]. March 28, 2006;Available at http://www.emedicine.com/ped/topic698.htm.

  7. Ta A, Sandler B. Common transient neonatal dermatoses. In: Harper J, Oranje A, Prose N, eds. Textbook of Pediatric Dermatology. London, England: Blackwell Science; 2000:59-61.

  8. Treadwell PA. Dermatoses in newborns. Am Fam Physician. Aug 1997;56(2):443-50. [Medline].

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

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Further Reading

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Keywords

vesicles, superficial pustules, pigmented macules, neonatal skin conditions, neonatal dermatoses

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Contributor Information and Disclosures

Author

Britt A Durham, MD, Co-Director of Risk Management, Assistant Professor, Department of Emergency Medicine, King-Drew Trauma Center and University of California at Los Angeles
Britt A Durham, MD is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Anne Laumann, MB, BCh, MRCP, FAAD, Associate Professor, Department of Dermatology, Feinberg School of Medicine, Northwestern University
Anne Laumann, MB, BCh, MRCP, FAAD is a member of the following medical societies: American Academy of Dermatology, Chicago Dermatological Society, Chicago Medical Society, Illinois Dermatological Society, Illinois State Medical Society, Illinois State Medical Society, Medical Dermatology Society, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Medical Editor

James Fulton Jr, MD, PhD, Medical Director, Fulton Skin Institute
James Fulton Jr, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Cosmetic Surgery, American Academy of Dermatology, Phi Beta Kappa, and Sigma Xi
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Van Perry, MD, Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas Health Science Center
Van Perry, MD is a member of the following medical societies: American Academy of Dermatology and American Society for Laser Medicine and Surgery
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other

 
 
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