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Transient Neonatal Pustular Melanosis Differential Diagnoses

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

Diagnostic Considerations

Also consider the following:

  • Acne neonatorum
  • Congenital candidiasis
  • Impetigo neonatorum
  • Erythema toxicum
  • Staphylococcal infection
  • Ofuji syndrome
  • Neonatal varicella
  • Congenital dermal melanocytosis or 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.

Failure to recognize and distinguish this condition from other neonatal pustular and vesicular dermatoses with more serious systemic implications can be problematic. Infectious causes of vesicles or pustules in the newborn can be bacterial (including spirochetal), fungal, or viral. Congenital herpes simplex infection is an important differential, although in this condition the vesicles and pustules occur in "crops" on erythematous bases.[9] Because pustules can be a manifestation of sepsis, it is important to consider all infectious etiologies.

Differential Diagnoses

Contributor Information and Disclosures

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.


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.


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.

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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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