Diagnostic Considerations

Also consider the following:

Acne neonatorum
Congenital candidiasis
Impetigo neonatorum
Erythema toxicum
Staphylococcal infection
Ofuji syndrome
Neonatal varicella
Congenital dermal melanocytosis or Mongolian spots: These are bluish-black macular patches on the back and lumbosacral area; they are more common in dark-skinned babies than in light-skinned babies.

Failure to recognize and distinguish this condition from other neonatal pustular and vesicular dermatoses with more serious systemic implications can be problematic. Infectious causes of vesicles or pustules in the newborn can be bacterial (including spirochetal), fungal, or viral. Congenital herpes simplex infection is an important differential, although in this condition the vesicles and pustules occur in "crops" on erythematous bases.^[12]Because pustules can be a manifestation of sepsis, it is important to consider all infectious etiologies.

Differential Diagnoses

Acropustulosis of Infancy
Congenital Dermal Melanocytosis (Mongolian Spot)
Dermatologic Manifestations of Herpes Simplex
Miliaria
Erythema Toxicum Neonatorum
Milia
Pediatric Syphilis

Workup

References

Chadha A, Jahnke M. Common Neonatal Rashes. Pediatr Ann. 2019 Jan 1. 48 (1):e16-e22. [QxMD MEDLINE Link].
Rayala BZ, Morrell DS. Common Skin Conditions in Children: Neonatal Skin Lesions. FP Essent. 2017 Feb. 453:11-17. [QxMD MEDLINE Link].
Taieb A, Boralevi F. Hypermelanoses of the newborn and of the infant. Dermatol Clin. 2007 Jul. 25(3):327-36, viii. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Wyre HW Jr, Murphy MO. Transient neonatal pustular melanosis. Arch Dermatol. 1979 Apr. 115(4):458. [QxMD MEDLINE Link].
Wagner A. Distinguishing vesicular and pustular disorders in the neonate. Curr Opin Pediatr. 1997 Aug. 9(4):396-405. [QxMD MEDLINE Link].
Auster B. Transient neonatal pustular melanosis. Cutis. 1978. 22:327-328.
Ramamurthy RS, Reveri M, Esterly NB, Fretzin DF, Pildes RS. Transient neonatal pustular melanosis. J Pediatr. 1976 May. 88(5):831-5. [QxMD MEDLINE Link].
Dinulos JG, Graham EA. Influence of culture and pigment on skin conditions in children. Pediatr Rev. 1998 Aug. 19(8):268-75. [QxMD MEDLINE Link].
Mengesha YM, Bennett ML. Pustular skin disorders: diagnosis and treatment. Am J Clin Dermatol. 2002. 3(6):389-400. [QxMD MEDLINE Link].
O'Connor NR, McLaughlin MR, Ham P. Newborn skin: Part I. Common rashes. Am Fam Physician. 2008 Jan 1. 77(1):47-52. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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.

Media Gallery

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

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Contributor Information and Disclosures

Author

Jennifer Sorrell, MD Adult and Pediatric Board-Certified Dermatologist

Jennifer Sorrell, MD is a member of the following medical societies: American Academy of Dermatology, Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Anne Elizabeth Laumann, MBChB, MRCP(UK), FAAD Professor Emerita of Dermatology, 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, American Academy of Dermatology Association, American College of Wound Healing and Tissue Repair, American Dermato-Epidemiology Network, Association for Psychoneurocutaneous Medicine of North America, Association of Professors of Dermatology, British Association of Dermatologists, Chicago Dermatological Society, Chicago Medical Society, Dermatology Foundation, European Society of Tattoo and Pigment Research, Illinois Dermatological Society, Illinois State Medical Society, Institute of Medicine of Chicago, Lupus Foundation of America, Illinois Chapter, Medical Dermatology Society, National Psoriasis Foundation, National Vitiligo Foundation, North American Rheumatologic Dermatology Society, Rheumatologic Dermatology Society, Scleroderma Foundation, Society for Investigative Dermatology, The Global Fibrosis Foundation, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

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: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

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.