Schachner noted that the differential diagnosis of noninfectious, usually benign neonatal vesiculopustular lesions includes acropustulosis of infancy; eosinophilic pustular folliculitis; erythema toxicum neonatorum; miliaria crystallina, rubra, or profunda; transient neonatal
pustular melanosis; and neonatal sucking blisters.
Vesiculopustular disorders of neonates are common; HSV infection, herpes zoster, congenital syphilis, neonatal acne, staphylococcal infections, bullous impetigo, epidermolysis bullosa simplex, Letterer-Siwe disease, transient
pustular melanosis, neonatal dermatitis herpetiformis, and IP all have vesiculopustular cutaneous manifestations.
Neonatal (birth-6 weeks) acne has a prevalence of 20%, though these lesions actually may represent acneiform conditions such as self-limited neonatal cephalic pustulosis or transient neonatal
pustular melanosis.
For example, the hyperpigmented macules or pustules that characterize transient neonatal
pustular melanosis are reported in 4.4% of African American infants and 0.2% of Caucasian infants.
The rare dermatoses, which we did not encounter in our study, include transient neonatal
pustular melanosis, subcutaneous fat necrosis of newborns, nevus sebaceous, port wine stain, supernumerary nipples and blue nevus.
Transient neonatal
pustular melanosis is more common in darker skin, compared with lighter skin; as many as 5% of African American newborns have this condition, Dr.