II. Definitions
- Transient Neonatal Pustular Melanosis
- Newborn Rash with vessicles and Pustules most common with dark complexion
III. Epidemiology: Incidence by ethnicity
- Black Infants: 4.4%
- White Infants: 0.2%
IV. Pathophysiology
- Benign condition affecting skin containing higher levels of Melanin
- Resolves spontaneously in first 3 months of life
V. Signs
- Size: 2 to 4 mm
- Pustular rash present at birth
- Initial: Milky fluid filled Pustule
- Next: Pustule ruptures
- Leaves a hyperpigmented Macule with scale (collarette appearance)
- Hyperpigmentation may persist for weeks to months before fading
- No surrounding erythema (contrast with Erythema Toxicum Neonatorum)
- Distribution
- Most common on the chin and neck, but also present on the forehead and behind the ears
- Also involves the trunk and buttocks
- Can be on palms and soles
VI. Differential Diagnosis
- See Neonatal Pustules and Vessicles
-
Erythema Toxicum Neonatorum variant
- Contrast with no surrounding erythema in Melanosis
- Infectious Pustules (contrast with the uniquely pigmented Macule in Melanosis)
VII. Labs
- Pustules contain Neutrophils on Gram Stain or wright stain
- Culture Negative
VIII. Management
- Reassurance for parents
IX. References
- Claudius and Behar in Herbert (2020) EM:Rap 20(8): 5-7
- Snyder (2024) Am Fam Physician 109(3): 212-6 [PubMed]