Neonatal Pustular Melanosis Clinical Presentation

  • Author: Robert A Silverman, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Mar 5, 2012
 

Physical

The primary lesions in neonatal pustular melanosis progress through 3 stages of development. Initially, they appear as rather uniform round 2-mm to 4-mm nonerythematous pustules. They are not clear vesicles; rather, they contain milky, purulent exudate. The pustules rupture easily. They are frequently missed because they are superficial and are usually wiped off easily in the delivery suite when the newborn is cleansed of vernix. Pustules on the thicker areas of skin such as the knees or palms may persist for several days.[3, 4]

Next, a delicate collarette of thin white scale is left around the perimeter of each denuded pustule. Near-term infants, especially those delivered by cesarean delivery, may exhibit just the unbroken pustules, and term infants may have only macules remaining, usually with the telltale collarette of flaking epidermis.

Lastly, within hours of exposure to the terrestrial environment, the central pigmented brown macule becomes apparent. The macules are round, have smooth and distinct borders, and are frequently confused for freckles. They may be profuse or sparse and typically are found under the chin and on the neck, upper chest, back, and buttocks. Occasionally, the palms, soles, and scalp are affected.

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Causes

The etiology is unknown. Some reports have described cases that evolved into erythema toxicum neonatorum;[5] however, in the author’s opinion, the disorders may coexist and are clinically distinct entities.

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Contributor Information and Disclosures
Author

Robert A Silverman, MD  Clinical Associate Professor, Department of Pediatrics, Georgetown University Medical Center

Robert A Silverman, MD is a member of the following medical societies: American Academy of Dermatology and Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Kevin P Connelly, DO  Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University School of Medicine; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center

Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Merrily P M Poth, MD  Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences

Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors at eMedicine gratefully acknowledge the contributions of previous author Elaine B St John, MD, to the original writing and development of this article.

References

  1. Eichenfield LF, Frieden IJ, Esterly NB, eds. Neonatal Dermatology. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2008:142.

  2. O'Connor NR, McLaughlin MR, Ham P. Newborn skin: Part I. Common rashes. Am Fam Physician. Jan 1 2008;77(1):47-52. [Medline].

  3. Chia PS, Leung C, Hsu YL, Lo CY. An infant with transient neonatal pustular melanosis presenting as pustules. Pediatr Neonatol. Dec 2010;51(6):356-8. [Medline].

  4. Goyal T, Varshney A, Bakshi SK. Incidence of Vesicobullous and Erosive Disorders of Neonates: Where and How Much to Worry?. Indian J Pediatr. Oct 25 2011;[Medline].

  5. Morgan AJ, Steen CJ, Schwartz RA, Janniger CK. Erythema toxicum neonatorum revisited. Cutis. Jan 2009;83(1):13-6. [Medline].

  6. Farnaroff AA, Martin RJ, eds. The skin. In: Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. 5th ed. St. Louis, Mo: Mosby-Year Book; 1992:1333-4.

  7. Ferrandiz 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].

  8. Merlob P, Metzker A, Reisner SH. Transient neonatal pustular melanosis. Am J Dis Child. Jun 1982;136(6):521-2. [Medline].

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

 
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