What is transient neonatal pustular melanosis?
Transient neonatal pustular melanosis is an uncommon benign pustular condition presenting in newborn infants [1]. It is also known as transient neonatal pustular dermatosis and transient neonatal pustulosis.
Neonatal pustular melanosis
Who gets transient neonatal pustular melanosis?
Transient neonatal pustular melanosis affects 0.2–4% of newborn infants in the first few days of life [2]. It is more common in African American babies than white American babies, affecting 4.4% of African American [3].
What causes transient neonatal pustular melanosis?
The cause of transient neonatal pustular melanosis is unknown. Some authors have suggested it may be a variant of toxic erythema of the newborn [4].
What are the clinical features of transient neonatal pustular melanosis?
The key clinical feature of transient neonatal pustular melanosis is the presence of pustules. These occur on an unaffected, non-erythematous base [1].
- Any area can be involved, including the patient's forehead, posterior ears, chin, neck, upper chest, back, buttocks, abdomen, thighs, palms, and soles [1].
- Lesions can be either solitary or occur in clusters [1].
- The pustules can rupture and crust, resolving within several days [1].
- The pustules may leave an area of hyperpigmentation, which fades within weeks to months [1].
- The pigmented macules can have a collarette of scale [2].
- The pustules are present at birth and evolve; new lesions usually do not develop after birth [1].
- There are no associated systemic symptoms or laboratory abnormalities.
How is transient neonatal pustular melanosis diagnosed?
The diagnosis of transient neonatal pustular melanosis is clinical. No investigations are required.
A skin biopsy shows a neutrophilic infiltrate in the epidermis or dermis, commonly with subcorneal pustules, and occasional eosinophils [2,5]. Pustules contain neutrophils with no organisms [1].
What is the differential diagnosis for transient neonatal pustular melanosis?
The differential diagnosis for transient neonatal pustular melanosis includes:
- Toxic erythema of the newborn
- Staphylococcal folliculitis and other bacterial, viral, and candida infections
- Miliaria
- Acropustulosis of infancy
- Neonatal cephalic pustulosis.
What is the treatment for transient neonatal pustular melanosis?
No treatment is necessary for transient neonatal pustular melanosis, as it is self-resolving and has no long-term complications [5,6].