eMedicine Specialties > Dermatology > Pediatric Diseases

Transient Neonatal Pustular Melanosis

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

Introduction

Background

Neonatal skin lesions are common and are frequent concerns for parents; therefore, recognition of the clinical diagnosis is important in order to reassure the family. Transient neonatal pustular melanosis is a benign skin condition with distinctive features characterized by vesicles, superficial pustules, and pigmented macules. The lesions are commonly present at birth and are most likely to appear on the chin, neck, forehead, chest, and back. Although less common, lesions may be seen on the palms and soles. The vesicles and pustules usually resolve within 48 hours, while the brown macules may persist for several months.

Frequency

United States

The rate of transient neonatal pustular melanosis is estimated to be 0.1-0.35% in white infants and 4-5% in black infants. The overall rate has been reported to be as high as 2.2%.

Mortality/Morbidity

Transient neonatal pustular melanosis is a benign, asymptomatic, and self-limiting skin eruption with no associated mortality or morbidity. Although melanotic macules usually resolve over several months, hyperpigmentation may be a rare long-term sequela.

Race

Transient neonatal pustular melanosis occurs in as many as 5% of African American newborns and in less than 0.4% of white infants.

Sex

This condition occurs equally in both sexes.

Age

Transient neonatal pustular melanosis is present at birth. Later phases of the rash may be visible for several months.

Clinical

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. Postterm infants are more likely to have pigmented macules.
• No systemic symptoms are associated with the skin lesions.

Physical

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

• Because of the fragile nature of the superficial pustules, most of them are broken in the initial drying or cleansing of newborns.
  • 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 with the neonate's first bath, leaving a white collarette of scale and brownish macules.
  • Therefore, depending on the time of the examination in the neonatal period, the vesicles, pustules, and pigmented macules may be found predominantly on the chin, neck, or forehead; behind the ears; or on the trunk, palms, and soles.
• The lesions are 2-10 mm in diameter. Vesicular eruptions are usually 2-4 mm and are often filled with milky fluid.
• No systemic signs 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. However, patients with acropustulosis have lesions that cluster on the palms and soles.

Causes

• The etiology is unknown.
• No familial predisposition has been identified.

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• Neonatal Pustular Melanosis (Pediatrics: General Medicine)