Transient neonatal pustular melanosis: A frequent misdiagnosis in neonates

Transient neonatal pustular melanosis: An unusual and challenging eruption

“…TNPM is a benign neonatal skin condition presenting at birth. The etiology is still unknown, but there is no familial predisposition or association with maternal infection or drug exposure 1,2 . It is uncommon, with an incidence ranging from 0.6% in white infants to 4.4% in black infants, with no sex predilection 3 .…”

“…The etiology is still unknown, but there is no familial predisposition or association with maternal infection or drug exposure. 1 , 2 It is uncommon, with an incidence ranging from 0.6% in white infants to 4.4% in black infants, with no sex predilection. 3 TNPM is self‐limiting and usually characterized by a generalized eruption of sterile pustules, 3 although in our case the eruption was primarily bullous.…”

“…1,3 Neonatal vesiculopustular eruptions could also be due to other serious pathologies, including active bacterial infections (e.g., Staphylococcus aureus, Streptococcus, Pseudomonas aeruginosa, and Listeria monocytogenes), congenital syphilis, viral infections (herpes, varicella, and cytomegalovirus), and congenital candida infection. 2,3 Other benign, transient neonatal pustular dermatoses include erythema toxicum neonatorum, miliary pustulosis, acne neonatorum, infantile acropustulosis, and eosinophilic pustulosis. [2][3][4] In some cases, such as ours, impressive clinical presentations might result in diagnostic uncertainty, leading to over-investigation and treatment.…”

“…2,3 Other benign, transient neonatal pustular dermatoses include erythema toxicum neonatorum, miliary pustulosis, acne neonatorum, infantile acropustulosis, and eosinophilic pustulosis. [2][3][4] In some cases, such as ours, impressive clinical presentations might result in diagnostic uncertainty, leading to over-investigation and treatment. Therefore, confident diagnosis is important to provide reassurance about TNPM's natural history.…”

“…In TNPM, these investigations should all be normal and not yield any organisms after 48 h. 1 Cytological examination of pustular fluid would show abundant polynuclear neutrophils and occasional eosinophils, in contrast to erythema toxicum neonatorum where infiltrates are predominantly eosinophilic. 2,3,6 A skin biopsy is not usually necessary; however, if performed, this would demonstrate subcorneal or intraepidermal pustules or vesicles. 1,3 Neonatal vesiculopustular eruptions could also be due to other serious pathologies, including active bacterial infections (e.g., Staphylococcus aureus, Streptococcus, Pseudomonas aeruginosa, and Listeria monocytogenes), congenital syphilis, viral infections (herpes, varicella, and cytomegalovirus), and congenital candida infection.…”