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Transient Neonatal Pustular Melanosis

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

Background

Neonatal skin lesions are common. Differentiation of the nonsignificant from more serious clinical entities is important.[1, 2] Transient neonatal pustular melanosis, a benign idiopathic skin condition mainly seen in newborns with skin of color, has distinctive features characterized by vesicles, superficial pustules, and pigmented macules. The lesions of transient neonatal pustular melanosis are present at birth. They occur on the chin, neck, forehead, chest, buttocks, back, and, less often, on the palms and soles.[3, 4] The vesicles and pustules rupture easily (see the image below) and resolve within 48 hours. The brown macules may persist for several months.[3, 5]

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

See 13 Common-to-Rare Infant Skin Conditions, a Critical Images slideshow, to help identify rashes, birthmarks, and other skin conditions encountered in infants.

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Epidemiology

US frequency

Previously published incidence rates for transient neonatal pustular melanosis are 0.6% in white infants and 4.4% in African American infants. The overall rate has been reported as 2.2%.[6] Transient neonatal pustular melanosis is more common in term-gestation infants.[7] Transient neonatal pustular melanosis has also been seen in non–African American infants with skin of color, although the literature is sparse.

Race

Transient neonatal pustular melanosis may occur in as many as 5% of African American newborns and less than 0.6% of white infants.

Sex

Transient neonatal pustular melanosis occurs equally in both sexes.[3]

Age

Transient neonatal pustular melanosis is present at birth

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Prognosis

Transient neonatal pustular melanosis is a benign, asymptomatic, and self-limited skin eruption with no associated mortality or morbidity. The prognosis for transient neonatal pustular melanosis is good. The vesicles and pustules usually resolve within 48 hours,[8] while the brown macules usually fade over 3-4 weeks but may persist for several months.[9]

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Patient Education

Reassure the parents that transient neonatal pustular melanosis is a benign, self-limiting condition.

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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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