Transient neonatal pustular melanosis
| Transient neonatal pustular melanosis | |
|---|---|
| Other names | Transient neonatal pustulosis[1] and lentigines neonatorum[2] |
 | |
| Transient neonatal pustular melanosis | |
| Specialty | Dermatology, pediatrics |
Transient neonatal pustular melanosis (TNPM), also known as pustular melanosis, is a type of neonatal pustular eruption that is a transient rash common in newborns. It is vesiculopustular rash made up of 1–3 mm fluid-filled lesions that rupture, leaving behind a collarette of scale and a brown macule.[3] The lesions are fragile and with no surrounding erythema.[3] This rash occurs only in the newborn stage, usually appearing a few days after birth,[4] but pigmented macules are sometimes already present at birth.[3] The rash usually fades over three to four weeks but may linger for up to three months after birth.[3] It can occur anywhere on the body, including the palms and soles.[4]
The cause of TNPM is unknown. It has been suggested that TNPM is merely a variant of erythema toxicum neonatorum[3] or a "precocious" form of erythema toxicum neonatorum.[5] No treatment is needed except for parental reassurance.
History
[edit]Transient neonatal pustular melanosis was initially described in 1961 as lentigines neonatorum[6] and as such was not fully distinguished from other similar rashes.
Transient neonatal pustular melanosis was clearly identified in 1976 by Ramamurthy et al.[6][7]
Causes
[edit]The cause of TNPM is unknown.[3]
It has been suggested that TNPM is merely a precocious form of erythema toxicum neonatorum based on the similar histopathology.[5]
Diagnosis
[edit]Transient neonatal pustular melanosis is diagnosed clinically, based on appearance alone, with no need for special testing. Proper identification is important to distinguish it from other serious, infectious neonatal diseases[3] and to help avoid unnecessary diagnostic testing and treatments.
A smear of the pustular contents will show polymorphic neutrophils and occasional eosinophils on Wright's stain.[3]
On histopathology, the pigmented macules will show basal and supra-basal increase in pigmentation without any pigmentary incontinence.[3] Bacterial culture will be negative.[5]
Increased frequency of placental squamous metaplasia has been reported in the mothers of some of these infants.[8]
Treatment
[edit]No treatment is needed except for parental reassurance. The rash spontaneously resolves, usually in three to four weeks, but the pigmented macules may linger for up to three months after birth.[3]
Epidemiology
[edit]The incidence of TNPM is 0.6% in white infants and 4.4% in African-American infants in the United States.[9] This rash also generally has a higher incidence in non-African-American infants with skin of color.[9]
There is significant regional variation and the incidence can vary widely in other nations. For example, in Brazil, transient neonatal pustular melanosis occurs in 9.6% of all newborns.[10]
TNPM occurs equally in both sexes.[9]
Genetic influence is unlikely as it has been reported in only one of pairs of identical twins.[10]
See also
[edit]References
[edit]- ^ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
- ^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. p. 476. ISBN 978-1-4160-2999-1.
- ^ a b c d e f g h i j Ghosh, S (March 2015). "Neonatal pustular dermatosis: an overview". Indian Journal of Dermatology. 60 (2): 211. doi:10.4103/0019-5154.152558 (inactive 1 November 2024). PMC 4372928. PMID 25814724.
{{cite journal}}: CS1 maint: DOI inactive as of November 2024 (link) - ^ a b Patrizi, A (2016). "Frequent newborn skin diseases". Clinical Dermatology. 3 (3–4): 82. doi:10.11138/cderm/2016.4.3.082.
- ^ a b c Ferrándiz, C; Coroleu, W; Ribera, M; Lorenzo, JC; Natal, A (1992). "Sterile transient neonatal pustulosis is a precocious form of erythema toxicum neonatorum". Dermatology. 185 (1): 18–22. doi:10.1159/000247396. PMID 1638066.
- ^ a b KagoTague, Daniel A.; Sunjah, Frida; Kenfack, Kelly; Chiabi, Andreas (2017). "Transient neonatal pustular melanosis: A frequent misdiagnosis in neonates". The Journal of Medical Research. 3 (1): 3–5. doi:10.31254/jmr.2017.3102.
- ^ Ramamurthy, RS; Reveri, M; Esterly, NB; Fretzin, DF; Pildes, RS (May 1976). "Transient neonatal pustular melanosis". Journal of Pediatrics. 88 (5): 831–835. doi:10.1016/S0022-3476(76)81126-2. PMID 1271148.
- ^ "Transient Neonatal Pustular Melanosis: Background, Etiology, Epidemiology". 18 May 2021.
- ^ a b c "Transient Neonatal Pustular Melanosis: Background, Etiology, Epidemiology". 18 May 2021.
- ^ a b Araújo, Tami de; Schachner, Lawrence (August 2006). "Erupções vesicopustulosas benignas no neonato". Anais Brasileiros de Dermatologia. 81 (4): 359–366. doi:10.1590/S0365-05962006000400009.