Transient Neonatal Pustular Melanosis

1. vesiculo-pustular lesions, may look alarming
2. rupture withing 12-48 hours, leaving small pigmented macules, often surrounded by fine white scale; these macules may remain for 3 mos.
3. benign, no tx
4. vesicle aspirate reveals neutrophils, no eos
5. in 5% of AA, 0.2% of caucasian

Pustules and small (2 to 3 mm in diameter) hyperpigmented macules are present at birth. The macules are surrounded by a collarette of scale that represents the remnant of a pustule roof. Although the clinical diagnosis usually is straightforward, if there is uncertainty, a Gram or Wright stain of pustule fluid will reveal polymorphonuclear neutrophils (PMNs) without organisms.