Pediatric Dermatology

Neonatal Transient pustular dermatosis- Non Infectious

Neonatal Transient pustular dermatosis- Non Infectious
Image credits:
  • Harper’s Textbook of Pediatric dermatology
  • Neonatal Pustular Dermatosis: An Overview Sangita Ghosh Indian J Dermatol. 2015 Mar-Apr; 60(2): 211. doi: 10.4103/0019-5154.152558
  • Dermatologyadvisor.com,
  •  Dermnetznz.org
Neonatal pustular eruption is a group of disorders characterized by various forms of pustulosis seen in the first 4 weeks of life.

Classification of Neonatal pustular dermatosis

Non Infectious pustular eruptions Infectious pustular eruptions.
  1. Erythema toxicum neonatorum
  2. Transient pustular melanosis
  3. Miliaria pustulosa
  4. Infantile acropustulosis
  5. Eosinophilic pustulosis
  6. Acne neonatorum
  7. Benign neonatal cephalic pustulosis
  8. Pustular eruption of Transient myeloproliferative disorder.
    1. Pustular psoriasis
(Note : 1-8 are Transient vesicopustular Eruptions of neonates)
  1. Bacterial: Impetigo, folliculitis, congenital syphilis, listeriosis (rare), and secondary bacterial infection of any primary dermatosis
  2. Viral: Herpes simplex virus infection, and varicella
  3. Fungal: Cutaneous candidiasis (congenital and neonatal), malassezia pustulosis.
Transient vesicopustular Eruptions of neonates

Dermatosis Onset and Duration Morphology and distribution Simple Lab Ix Image
ETN

(Erythema toxicum neonatorum)

1st or 2nd day of life, upto 4th day of life

Persists- 3-7 days

Resolves spontaneously

1-3cm dia Blotchy erythematous macules with a 1 to 4 mm central vesicle or pustule 

Sites : Trunk (profuse),also face and proximal limbs Note : spares palms and soles

Smear- WS: eosinophils

20% cases show peripheral esonophilia

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TNPM

(Transient neonatal pustular melanosis)

Present from birth

Pustules rupture over 3-4 days but pigmented macules can persist up to  months

Resolves spontaneously

1–3 mm, flaccid, superficial, fragile pustules with no surrounding erythema

Sites: chin, neck, forehead, back, and buttocks, even palms and soles may be involved

Smear: numerous neutrophils with few eosinophils
Miliaria Pustulosa

(sweat retention due to obstruction of sweat glands)

Can occur anytime during or after neonatal periodCan persist for weeks .

 Has tendency to recur

crops of superficial vesicles and pustules admixed with miliaria rubra

Sites: upper back, flexures, forehead, and neck

Smear : WS: squamous cells
Neonatal and Infantile Acropustulosis

(AKA Ofuji’s disease)

Can present anytime during the first 3 months of life

Each crop lasts for 1-2 weeks

Has tendency to recur

pruritic, sterile vesiculopustules 

Site : Predilection for the palms and soles

Lesions can extend on limbs

Smear : WS: predominant neutrophils with few eosinophils 
Esonophilic Pustulosis

(Aka eosinophilic pustular folliculitis)

Onset- first 6 months of life (25% of them present at or just after birth)

Each crop lasts for 1-2 weeks with a tendency to recur

Spontaneous resolution occurs mostly between 4 and 36 months

recurrent crops of pruritic annular or polycyclic plaques, composed of coalescing sterile papulopustules 

Sites : seborrheic areas of the scalp, face, trunk, and extremities

Smear: WS: abundant eosinophils
Neonatal Acne Onset : first few weeks of life 

Persists upto 3 months

Superficial papulopustules (note : no comedones)

Site: cheeks (most common ), nose , forehead, 

Clinical Dx. Smear not warranted
Transient neonatal cephalic pustulosis

(Aka neonatal malasezzia furfur pustulosis (NMFP))

Criteria  (1) pustules on face and neck, (2) age at onset, younger than 1 month, (3) isolation of M. furfur by direct microscopy in pustular material, (4) elimination of other causes of pustular eruption, (5) response to topical ketoconazole therapy erythematous papulopustules, surrounded by erythematous halo (no comedones)

Sites:  cheeks, chin, eyelids, neck and upper chest

Resolves spontaneously

KOH: spaghetti and meatball appearance if malassezia is present
Pustular eruption of transient myeloproliferative disorder 10–20% of newborn with down syndrome or neonates with trisomy 21 mosaicism

Onset : at birth or within first 2 days

diminish spontaneously in 1 to 3 months

pancytopenia, hepatosplenomegaly, and immature circulating WBCs

Eruptions of papules and pustules

Sites: face- cheeks, also on trunk and extremities . over sites of trauma such as venipuncture sites or under adhesive tape

Smear :

Blast cells (from superficial pustules within 3 days of eruption)

 

References:

  1. Neonatal Pustular Dermatosis: An Overview Sangita Ghosh Indian J Dermatol. 2015 Mar-Apr; 60(2): 211. doi: 10.4103/0019-5154.152558
  2. Harper’s Textbook of Paediatric dermatology
  3. Vesiculopustular Eruption in Neonatal Transient Myeloproliferative Disorder Iraz Nar & Ozge Surmeli-Onay & Selin Aytac & Beril Talim & Pelin Ozlem Kiper & Koray Boduroglu & Murat Yurdakok
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