Transient Neonatal Pustular Melanosis (TNPM)

What is transient neonatal pustular melanosis (TNPM)?

Transient neonatal pustular melanosis (TNPM) is a normal and harmless skin condition that affects newborns. Infants with TNPM have skin bumps called pustules that are noticeable at birth. These pus-filled bumps rupture, causing white-encircled dark spots on the skin. These spots eventually fade. TNPM is benign (not cancerous). It doesn’t itch or scar. The condition goes away without treatment.

What does “transient neonatal pustular melanosis” mean?

Breaking down the meaning of each word may help you better understand this condition:

• Transient means for a short time. TNPM is a temporary condition.
• Neonatal means newborns.
• Pustular refers to a small, swollen skin bump that contains pus.
• Melanosis refers to a darkening of skin color.

How common is TNPM?

TNPM is not common. This skin disease affects 2.2% of infants.

What causes transient neonatal pustular melanosis (TNPM)?

Experts don’t know why some babies are born with TNPM. It affects boys and girls equally. Full-term infants are more likely to have this skin condition than those who are born early.

What are the symptoms of TNMP?

TNMP causes small pus-filled bumps and/or blisters on a newborn’s skin. Symptoms include:

• Black, brown, red or purple bumps on dark skin. Yellow, white or gray bumps on lighter-colored skin.
• No redness around the base of the bump.
• Very small bumps (less than 1//10 of an inch or 3 millimeters) that may resemble a blister, baby acne or skin rash.
• A single bump or many bumps that cluster together.
• Blisters that break open easily, scab over and heal within 48 hours.
• Discolored or darker skin at the site of the healed blister.
• White rim or collar (called collarette of scale) around the dark, flat skin spots.
• Gradual fading of the discolored skin spots in three to four weeks.

What parts of the body does TNMP affect?

TNMP skin lesions can appear anywhere on a child.

How is transient neonatal pustular melanosis (TNPM) diagnosed?

Your child’s healthcare provider can make a diagnosis by examining the bumps. Your child shouldn’t need special testing.

In rare instances, a dermatologist (skin specialist) performs a skin biopsy to examine pustule fluid or tissue under a microscope. If a child has TNPM, the biopsy sample will have white blood cells called neutrophils. The condition is benign, so there won’t be cancer cells.

What conditions cause symptoms similar to TNPM?

Your child’s healthcare provider may perform a biopsy to confirm a TNPM diagnosis and rule out conditions that cause similar symptoms, such as:

• Acropustulosis of infancy (an itchy skin rash on the hands or feet).
• Baby acne.
• Bacterial, viral or yeast infections.
• Cradle cap (seborrheic dermatitis in infants).
• Erythema toxicum neonatorum or toxic erythema of the newborn (a harmless skin rash that appears after childbirth).
• Milia (harmless white skin cysts).
• Miliaria (a rash caused by heat illness).
• Staph infection.

How is transient neonatal pustular melanosis (TNPM) treated?

The bumps from TNPM go away without treatment. Because the blisters break open easily, you should take extra care when bathing and changing your baby. Ask your child’s healthcare provider about what bathing and moisturizing products to use.

Can you prevent transient neonatal pustular melanosis (TNPM)?

Medical experts aren’t sure why some babies are born with this skin condition. There isn’t anything you can do to prevent it.

What is the outlook for a child with transient neonatal pustular melanosis (TNPM)?

There are no long-term effects from TNPM. The blisters don’t scar or itch. And the discolored skin fades in a few weeks. In time, you won’t be able to tell that your child ever had this skin condition.

When should I call the doctor?

Call your healthcare provider if your child experiences signs of an infection, such as:

• Difficulty swallowing (dysphagia).
• Inflammation or swelling (edema).
• Fever.
• Fewer wet diapers (low urine output).
• Red streaks on the skin.
• Shortness of breath (dyspnea).
• Swollen lymph nodes.

What should I ask my provider?

You may want to ask your healthcare provider:

• What bath products and lotions are safe for my baby?
• Should I look for signs of complications?

A note from Cleveland Clinic

Seeing bumps on your newborn’s skin can come as a shock. Most skin conditions that affect infants are harmless and temporary. While blisters and skin discoloration from TNPM may look unsightly, your child isn’t in pain and won’t have scars or any long-term effects. The condition goes away without treatment. You should talk to your child’s healthcare provider if you have concerns about how to bathe and care for your baby while the blisters are present or healing.