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Pediatr Ann 2019 Jan;48(1):e16-e22

Skin eruptions are commonly encountered in the neonatal and infant period and can be a source of concern for providers and parents alike. We present a brief, clinically focused discussion on topics commonly encountered by the pediatrician with a focus on pearls of knowledge to help distinguish diseases from one another and from more serious conditions. We review miliaria, transient neonatal pustular melanosis, neonatal cephalic pustulosis, erythema toxicum neonatorum, diaper dermatitis, seborrheic dermatitis, and atopic dermatitis. Read More

Pediatr Dermatol 2017 Jul 25;34(4):422-426. Epub 2017 May 25.

Department of Dermatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.

Background/objectives: Erythema toxicum neonatorum (ETN) and transient neonatal pustular melanosis (TNPM) are benign pustular skin conditions that are relatively common in newborns, but the predisposing factors for these conditions are unknown. Our goal was to verify the prevalence of ETN and TNPM and their predisposing factors in a large sample of neonates.

Methods: In this prospective 1-year multicenter study, 2,831 neonates (age ≤72 hours) born in southern Brazil were randomized to undergo skin examination by a dermatologist. Read More

FP Essent 2017 Feb;453:11-17

University of North Carolina Chapel Hill School of Medicine Dermatology Residency Program, 410 Market St. Suite 400 CB#7715, Chapel Hill, NC 27516.

Skin findings during the initial month of life are ubiquitous. One study estimated that more than 95% of newborns have cutaneous findings, which often are distressing to parents but frequently are benign and self-limited. Among them are milia, cutis marmorata, congenital dermal melanocytosis, and the benign neonatal pustular eruptions (eg, benign cephalic pustulosis, erythema toxicum neonatorum, transient neonatal pustular melanosis). Read More

An Bras Dermatol 2016 Apr;91(2):124-34

Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.

The neonatal period comprises the first four weeks of life. It is a period of adaptation where the skin often presents several changes: transient lesions, resulting from a physiological response, others as a consequence of transient diseases and some as markers of severe disorders. The presence of pustules in the skin of the newborn is always a reason for the family and for the assisting doctor to be worried, since the newborn is especially vulnerable to bacterial, viral or fungal infection. Read More

Ned Tijdschr Geneeskd 2016 ;160:A9279

Alrijne Ziekenhuis Leiden, afd.Kindergeneeskunde, Leiden.

We describe a female neonate with non-grouped pustules directly postpartum without clinical signs of illness. There were no red maculae. At follow-up some pustules had turned to pigmented maculae, which confirmed the diagnosis of neonatal pustular melanosis. Read More

Indian J Dermatol 2015 Mar-Apr;60(2):211

Department of Skin and VD, PGIMS, Rohtak, Haryana, India.

Neonatal pustular eruption is a group of disorders characterized by various forms of pustulosis seen in first 4 weeks of life. Its presentation is often similar with some subtle differences, which can be further established by few simple laboratory aids, to arrive at a definite diagnosis. Given their ubiquitous presentation, it is sometimes difficult to differentiate among self-limiting, noninfectious, pustular dermatosis such as erythema toxicum neonatorum, transient neonatal pustular melanosis, miliaria pustulosa, etc. Read More

Eur J Pediatr 2014 Dec 7;173(12):1655-8. Epub 2013 Dec 7.

Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy,

Unlabelled: A newborn's skin may exhibit a variety of changes during the first weeks of life, and rashes are extremely common in the neonatal period, representing a significant source of parental concern. In particular, a variety of skin eruptions can present as pustules. Most of them are innocuous and self-limiting, while others can be the manifestation of an infectious disease or even indicative of serious underlying disorders. Read More

Arch Dis Child Fetal Neonatal Ed 2013 Nov 9;98(6):F492. Epub 2013 Mar 9.

Department of Pediatrics, Institute for Maternal and Child Health IRCCS "Burlo Garofolo" Trieste, University of Trieste, , Trieste, Italy.

Ann Dermatol 2013 Feb 14;25(1):1-4. Epub 2013 Feb 14.

Department of Dermatology, Ankara Etlik Ihtisas Education and Research Hospital, Ankara, Turkey.

Background: Cutaneous lesions are commonly seen in the newborn period and exhibit inconsistency from the skin lesions of an adult.

Objective: The present study was carried out with an aim to determine the frequency of physiologic and pathologic cutaneous findings in newborns.

Methods: Typically, 1234 newborns were included in this study. Read More

Actas Dermosifiliogr 2013 Jan 11;104(1):84-5. Epub 2012 Aug 11.

J Dermatol Case Rep 2011 Dec;5(4):58-63

Department of Dermatology Venereology and Leprology, Muzaffarnagar Medical College and Hospital, Muzaffarnagar, Uttar Pradesh, India.

Background: The entity vesicobullous disorders in neonates encompasses a varied spectrum of disorders varying from self limiting to potentially life threatening infectious diseases.

Objective: To analyse the incidence of dermatoses in neonates, stress the importance of simple noninvasive diagnostic procedures with perspective to actual need of active intervention.

Patients And Methods: Forty four neonates with vesicobullous lesions in departments of dermatology and pediatrics were evaluated with respect to diagnosis, required treatments and follow ups. Read More

Ned Tijdschr Geneeskd 2012 ;156(6):A2816

Orbis Medisch Centrum, afd. Kindergeneeskunde, Sittard, the Netherlands.

We present a neonate with transient neonatal pustular melanosis, a benign skin rash seen in 0.2-2.2% of white neonates and in 4-5% of black neonates. Read More

Indian J Pediatr 2011 Oct 25. Epub 2011 Oct 25.

Department of Dermatology, Venereology and Leprology, Muzaffarnagar Medical College and Hospital, Muzaffarnagar, Uttar Pradesh, India.

Objective: To analyse the incidence of dermatoses in neonates, stress the importance of simple noninvasive diagnostic procedures with perspective to actual need of active intervention.

Methods: Forty four neonates with vesicobullous lesions in Departments of Dermatology and Pediatrics were evaluated with respect to diagnosis, required treatments and follow ups.

Results: Of the total 44 neonates, 29 were boys and 15 girls. Read More

Arch Pediatr 2011 Mar 1;18(3):291-3. Epub 2011 Feb 1.

Service de dermatologie - EPS La Rabta, La Rabta Hospital, rue Jabbari, 1007 Tunis, Tunisie.

Transient neonatal pustular melanosis is a common, benign, but little known dermatosis in newborns. Diagnosis of transient neonatal pustular melanosis is made clinically, by the presence of vesiculopustular and pigmented macular skin lesions. This benign spontaneously regressive dermatosis should be distinguished from several serious infectious neonatal diseases. Read More

Pediatr Neonatol 2010 Dec;51(6):356-8

Department of Pediatrics, Far Eastern Memorial Hospital, No. 21 Sec. 2 Na Ya South Road, Panchiao, Taipei, Taiwan.

Transient neonatal pustular melanosis is mostly found in full-term black infants. It is a benign and self-limited disease, and the etiology is still unknown. We present a full-term female neonate with multiple vesiculopustular and pigmented macular lesions found immediately after her birth. Read More

Przegl Lek 2009 ;66(9):535-7

Ambulatorium z Izba Chorych, 6 Wojskowy Oddział Gospodarczy w Ustce.

The skin of newborns differs from adult skin in many aspects. It is in the developing age which makes it difficult to fulfill it's correct function. There are diseases which appear in the first month of the infants life and require treatment. Read More

Am Fam Physician 2008 Jan;77(1):47-52

Chestnut Hill Hospital Family Practice Residency Program, Philadelphia, Pennsylvania, USA.

Rashes are extremely common in newborns and can be a significant source of parental concern. Although most rashes are transient and benign, some require additional work-up. Erythema toxicum neonatorum, acne neonatorum, and transient neonatal pustular melanosis are transient vesiculopustular rashes that can be diagnosed clinically based on their distinctive appearances. Read More

Ned Tijdschr Geneeskd 2007 Feb;151(5):277-83

Isala klinieken, Amalia Kinderafdeling, Postbus 10.400, 8000 GK Zwolle.

Four neonates with vesicopustular skin eruptions, 1 girl and 3 boys, were diagnosed with feeding blisters, bullous impetigo, erythema toxicum neonatorum and transient neonatal pustular melanosis, respectively. The neonate with bullous impetigo was treated with antibiotics; the remaining neonates were not treated. The neonate with transient neonatal pustular melanosis developed hyperpigmentation, whereas the other neonates recovered without sequelae. Read More

Indian J Dermatol Venereol Leprol 2006 May-Jun;72(3):211-4

Department of Pathology, Govt. Medical College, Chandigarh, India.

Background And Aims: Langerhans cell histiocytosis (LCH) is a rare proliferative disorder of histiocytes characterized by a proliferation of abnormal and clonal Langerhans cells. We retrospectively studied clinicopathologic features of this disorder in five cases.

Methods: Clinical and histopathological findings of five cases of cutaneous LCH were reviewed based on the hospital records. Read More

Am J Clin Dermatol 2002 ;3(6):389-400

Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.

The differential diagnosis for pustular skin disorders is extensive. The distribution of the lesions and the age of the patient are characteristics that may provide strong clues to the etiology of cutaneous pustular eruptions. In adults, generalized pustular dermatoses include pustular psoriasis, Reiter's disease and subcorneal pustular dermatosis. Read More

Clin Exp Dermatol 2001 May;26(3):251-5

Department of Dermatology, King's College Hospital, London, UK.

Eosinophilic pustular folliculitis (EPF) of infancy is a rare disorder which may begin in the neonatal period and cause considerable parental anxiety. It must be distinguished from other causes of a pustular eruption in neonates, including infection and erythema toxicum neonatorum, and rare disorders such as transient neonatal pustular melanosis, infantile acropustulosis and Langerhans' cell histiocytosis. Skin smears and occasionally skin biopsy may be necessary to reach a diagnosis. Read More

Curr Opin Pediatr 1997 Aug;9(4):396-405

Northwestern University, Children's Memorial Hospital, Chicago, IL 60614, USA.

Vesicular and pustular disorders are common in the neonatal period. Most are benign, but several serious infectious and noninfectious diseases can present in the neonate. This review focuses on the clinical features of these disorders as well as recent advances in the field. Read More

Am Fam Physician 1997 Aug;56(2):443-50

Indiana University School of Medicine, Indianapolis, USA.

Benign dermatoses in newborns must be distinguished from more serious disorders with cutaneous manifestations. Erythema toxicum neonatorum, transient neonatal pustular melanosis, sucking blister, miliaria and mongolian spots are among the many benign skin conditions that can occur in newborns. Recognition of these dermatoses allows the physician to proceed appropriately, reassure the parents and initiate further evaluation or treatment as necessary. Read More

Pediatr Dermatol 1997 Mar-Apr;14(2):131-43

Department of Dermatology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.

The diagnosis of a pustular dermatosis occurring during the first months of life is usually based on clinical findings. However, some cases may require simple investigations including microscopic examination of pustular content, cultures, and skin biopsies. The main benign transient neonatal types of pustulosis include erythema toxicum neonatorum, infantile acropustulosis, transient neonatal pustular melanosis, and neonatal acne. Read More

Am Fam Physician 1995 May;51(6):1401

Semin Dermatol 1995 Mar;14(1):15-20

Department of Dermatology, State University of New York, Brooklyn 11203, USA.

Skin diseases in black children differ because of pigment lability, fibroblastic activity, and folliular predominance. Normal findings may include Futcher's or Voight's line, linea alba, Mongolian spot, and pigmentation of the mucous membranes and nails. Disorders that are more frequent in black children are transient neonatal pustular melanosis, infantile acropustulosis, tinea capitis, pomade acne, traction alopecia, and proximal trichorrhexis nodosa. Read More

Ann Pediatr (Paris) 1992 Sep;39(7):397-406

Service de Dermatologie, Hôpital Saint-Louis, Paris.

The diagnosis of pustular dermatosis occurring during the first months of life is usually based on clinical findings. However, some cases may require a few simple investigations including cytological studies, cultures, and skin biopsies. The most common causes of infectious pustular skin lesions include bacterial infections, which may be septicemic (with Listeria as the leading causative agent) or initially localized (staphylococcus); viral infections (varicella, herpes); fungal infections, i. Read More

Dermatology 1992 ;185(1):18-22

Department of Dermatology, Hospital Universitario de Badalona Germans Trias i Pujol, Universitat Autonoma of Barcelona, Spain.

A sterile pustular skin eruption was observed in 17 of 3,541 newborn infants examined over a period of 30 months. The skin eruption was always present at birth and fulfilled the clinical criteria of transient neonatal pustular melanosis (TNPM). However, some days after birth, all of them but 1 developed skin lesions typical of erythema toxicum neonatorum (ETN). Read More

An Esp Pediatr 1990 Aug;33(2):117-9

Servicio de Pediatría, Hospital Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona.

Ten newborn infants with transient neonatal pustular melanosis are reported. The incidence (0.59%), the most noticeable clinical aspects and the differential diagnosis are pointed out. Read More

Hautarzt 1989 Aug;40(8):501-3

Dermatologische Universitätsklinik Ulm/Donau.

Infantile acropustulosis starts in the first few months of life with the recurrent appearance of pruritic intraepidermal pustules containing neutrophils. Predilection sites are the hands and feet. Episodes of pustular eruptions lasting from 8 to 14 days are followed by longer intervals with no symptoms. Read More

G Ital Dermatol Venereol 1985 Nov-Dec;120(6):409-12

Hautarzt 1985 Aug;36(8):475-7

A girl with widespread vesicular pustular lesions present at birth is reported. The differential diagnosis is discussed, with an extreme eruption of erythema toxicum neonatorum and the newly described entity transient neonatal pustular melanosis (TNPM) under consideration. This benign, self-limited, pustular eruption, with lesions present at birth, requires no specific therapy, but must be distinguished from the neonatal skin manifestations of viral, bacterial and fungal diseases. Read More

Am J Dis Child 1982 Jun;136(6):521-2

Int J Dermatol 1979 Oct;18(8):636-8

A Mexican-American boy presented at birth with an extensive eruption consisting of 0.5 to 1.0 cm hyperpigmented macules with a distinct peripheral scale involving primarily the forearms, abdomen and lower back (Fig. Read More

Arch Dermatol 1979 Apr;115(4):458

A black male infant had congenital lesions that consisted of pigmented macules, many of which had a peripheral collarette of scale, and vesicopustules. The appearance of this patient fit the clinical syndrome of transient neonatal pustular melanosis, a newly described vesicopustular disease of the newborn. Differential diagnosis in this patient included the following conditions: erythema toxicum neonatorum, staphylococcal pyoderma, and herpes simplex. Read More

J Pediatr 1976 May;88(5):831-5

Newborn infants were observed with vesicopustular and pigmented macular skin lesions, which occurred more commonly in black and mature infants and which were distinct clinically and histopathologically from erythema toxicum. Histopathology of skin biopsies of the vesicopustules is characterized by polymorphonuclear infiltration. The lesions often present as, or evolve into, a pigmented macule and persist from three weeks to three months. Read More