Which neonatal skin finding is described as transient and benign and frequently confused with infectious lesions?

• A. Erythema toxicum
• B. Neonatal pustular melanosis
• C. Milia
• D. Miliaria crystalline

Answer: (B)

The key idea is recognizing a benign neonatal eruption that can look like an infection but isn’t. Neonatal pustular melanosis presents with pustules that appear at birth and may rupture, leaving dark hyperpigmented macules with a scaly rim. These lesions are noninfectious and self-limited, and there are no systemic signs such as fever or poor feeding. Because the early lesions resemble bacterial pustules, clinicians and families can mistake them for infection, which is why it’s frequently confused with infectious lesions. The course is benign and the pustular phase is transient, with the skin changes eventually resolving over weeks to months, though the pigmented macules can persist longer. This combination of birth-present pustules that are sterile and self-resolve, along with the potential for confusion with infection, makes neonatal pustular melanosis the best fit for this description.