You are in: eMedicine Specialties > Pediatrics: General Medicine > Dermatology Neonatal Pustular MelanosisArticle Last Updated: Mar 28, 2006AUTHOR AND EDITOR INFORMATIONSection 1 of 10
  Author: Elaine B St John, MD, Associate Professor of Pediatrics, Division of Neonatology, University of Alabama at Birmingham School of Medicine Elaine B St John is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, Society for Pediatric Research, and Southern Society for Pediatric Research Editors: Kevin P Connelly, DO, Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University; Medical Director, Paws for Health Pet Visitation Program; Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc; Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School; Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences; Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center Author and Editor Disclosure Synonyms and related keywords: neonatal pustular melanosis, transient pustular melanosis of the newborn, pustular melanosis, lesions, vesicles, macules, rash INTRODUCTIONSection 2 of 10
  BackgroundNeonatal pustular melanosis is a benign self-limited condition of unknown etiology. Historically, the disorder has been lumped together with other vesicular and bullous lesions and called pemphigus neonatorum; it was not described as a separate entity until 1976. Recognizing the classic findings of neonatal pustular melanosis is important in order to eliminate further workup and reassure the patient's family. Note that scabies is a common cause of pustules on the hands and feet. Careful examination for the presence of burrows is mandatory. FrequencyUnited StatesFew reports of large numbers of screened infants exist; however, incidence has been reported to be as high as 2.2% in white infants and 4.4% in black infants. Mortality/MorbidityNeonatal pustular melanosis is a completely benign condition that is not known to cause any long-term sequelae. RaceNeonatal pustular melanosis is twice as common in black infants as in white infants. AgeLesions are present at birth as vesicles, macules, or a combination of both. CLINICALSection 3 of 10
PhysicalThe eruption is present at birth and consists of 2- to 4-mm nonerythematous vesicles filled with a milky fluid. These vesicles rupture, leaving a collarette of white scales and a central pigmented macule. The pigmented spots may persist for as long as 3 months. Near-term infants may exhibit just the unbroken vesicles, and term infants may have only macules remaining, usually with the telltale collarette of flaking epidermis. The lesions may be profuse or sparse and typically are found under the chin and on the neck, upper chest, lower back, and buttocks. Occasionally, the palms, soles, and scalp also may be affected. CausesThe cause is not known. Some reports have described cases that evolved to erythema toxicum, but larger studies seem to indicate that incidence of erythema toxicum in infants with neonatal pustular melanosis is similar to that in the nonaffected population. DIFFERENTIALSSection 4 of 10
Acropustulosis Candidiasis Erythema Toxicum Herpes Simplex Virus Infection Milia Staphylococcus Aureus Infection
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