Smears of pustular material from neonatal pustular melanosis reveal predominantly:

• A. Bacteria
• B. Eosinophils
• C. Lymphocytes
• D. Neutrophils

Answer: (D)

Pustular melanosis in newborns involves sterile pustules that form from an acute neutrophilic response in the epidermis. Because these lesions are not caused by an ongoing infection, the material inside the pustules is filled primarily with neutrophils. A smear will show many neutrophils with few or no organisms, which helps distinguish this condition from infectious pustules like impetigo where bacteria are present. Eosinophils would suggest allergic or parasitic processes, and lymphocytes point toward a different, often viral or chronic, immune response. So the predominance of neutrophils reflects an acute, sterile neutrophilic reaction in the lesion.