Neonatal Pustular Melanosis Workup

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

Laboratory Studies

If the appearance is typical of transient neonatal pustular melanosis, no further workup is indicated. If appearance is not typical, potassium hydroxide preparation, Gram stain, and Wright-Giemsa stain can support other diagnoses in the differential. In atypical cases, pustules can be cultured for bacteria and clustering of pustules should prompt polymerase chain reaction to identify possible herpes simplex.

Wright-Giemsa stain of pustule contents demonstrates a predominance of neutrophils. Few, if any eosinophils are present. The brown macules are not true freckles or lentigines. Skin biopsy shows pigment incontinence characteristic of postinflammatory hyperpigmentation. The diagnosis of Langherhans cell histiocytosis can only be made by skin biopsy.

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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.

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  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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