Background
Neonatal skin lesions are common. Differentiation of the nonsignificant from more serious clinical entities is important. [1, 2, 3, 4] Transient neonatal pustular melanosis, a benign idiopathic skin condition mainly seen in newborns with skin of color, has distinctive features characterized by vesicles, superficial pustules, and pigmented macules. The lesions of transient neonatal pustular melanosis are present at birth. They occur on the chin, neck, forehead, chest, buttocks, back, and, less often, on the palms and soles. [5, 6] The vesicles and pustules rupture easily (see the image below) and resolve within 48 hours. The brown macules may persist for several months. [5, 7]
Ruptured pustules and vesicles with remaining characteristic collarette of scale and brown hyperpigmented macules. Courtesy of Anthony J. Mancini, MD.
See 13 Common-to-Rare Infant Skin Conditions, a Critical Images slideshow, to help identify rashes, birthmarks, and other skin conditions encountered in infants.
Etiology
The etiology of transient neonatal pustular melanosis is unknown. No familial predisposition has been identified for transient neonatal pustular melanosis.
Increased frequency of placental squamous metaplasia has been reported in the mothers of some of these infants, although this relationship has not been demonstrated in any large trial. [8]
Epidemiology
US frequency
Previously published incidence rates for transient neonatal pustular melanosis are 0.6% in white infants and 4.4% in African American infants. The overall rate has been reported as 2.2%. [9] Transient neonatal pustular melanosis is more common in term-gestation infants. [10] Transient neonatal pustular melanosis has also been seen in non–African American infants with skin of color, although the literature is sparse.
Race
Transient neonatal pustular melanosis may occur in as many as 5% of African American newborns and less than 0.6% of white infants.
Sex
Transient neonatal pustular melanosis occurs equally in both sexes. [5]
Age
Transient neonatal pustular melanosis is present at birth
Prognosis
Transient neonatal pustular melanosis is a benign, asymptomatic, and self-limited skin eruption with no associated mortality or morbidity. The prognosis for transient neonatal pustular melanosis is good. The vesicles and pustules usually resolve within 48 hours, [11] while the brown macules usually fade over 3-4 weeks but may persist for several months. [12]
Patient Education
Reassure the parents that transient neonatal pustular melanosis is a benign, self-limiting condition.
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Ruptured pustules and vesicles with remaining characteristic collarette of scale and brown hyperpigmented macules. Courtesy of Anthony J. Mancini, MD.
