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]
| Transient neonatal pustular melanosis | |
|---|---|
| Other names | Transient neonatal pustulosis[1] and lentigines neonatorum[2] |
 | |
| Transient neonatal pustular melanosis | |
| Specialty | Dermatology, pediatrics |
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
editTransient 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
editThe 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
editTransient 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
editNo 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
editThe 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
editReferences
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.