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Transient Neonatal Pustular Melanosis Workup

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

Laboratory Studies

The diagnosis of transient neonatal pustular melanosis is usually made by clinical examination.

A Tzanck smear with a cellular stain (eg, Wright-Giemsa stain) or Gram stain of the contents of a pustule reveals a predominance of neutrophils and occasional eosinophils and cellular debris.[3, 8, 9] No evidence of bacterial, yeast, or viral infection is found. Gram stain preparations for bacteria are negative. Blood and skin culture results are negative.


Histologic Findings

Vesicopustules of transient neonatal pustular melanosis show intracorneal and subcorneal collections of neutrophils with occasional eosinophils, mild acanthosis, and some intraepidermal edema. Occasionally, fragmented hairs may be seen in the blister cavity. Dermal inflammatory infiltrate is extremely minimal. Pigmented macules reveal a basket-weave, slightly hyperkeratotic stratum corneum[6] together with hypermelanosis in the epidermal basal cells, but no melanin in the dermis.[11, 12]

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.

  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.

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