Transient Neonatal Pustular Melanosis Transient Neonatal Pustular Melanosis or TNPM is usually present at delivery TNPM is characterized by small pustules (0.3 to 0.5 cm) on a nonerythematous base These pustules rupture easily, and pigmented macules develop with surrounding collarettes of scales that may persist for weeks to months The pustules are mostly located over the forehead, neck, and lower back, but occasionally, palms and soles may be involved ( Fig 69.3 ) No systemic manifestations have been reported Staphylococcal Pustulosis If a neonate presents after 48 hours of life with new pustules, it is important to consider infection with staphylococcus or candida Staphylococcal pustulosis is relatively common and can occur in the setting of infection of the umbilicus or circumcision site Community-acquired S aureus is common, and a history of staph infection in close contacts may aid in diagnosis Simple bacterial swabs are the primary diagnostic tool Pustules on the lower abdomen and in the diaper area are common A small number of pustules, in an otherwise healthy neonate, can often be treated with oral and/or topical antibiotics Providers should look for peeling in the folds of the skin and very red or hot skin because this can be a sign of staphylococcal scalded skin ( Fig 69.4 ) Neonatal Candida Congenital candidiasis usually presents within 12 hours of birth as redness on the affected area and then later with pustules with desquamation Candida albicans and Candida psiloparis are the most common causes of neonatal candida infections In full-term healthy infants, congenital candida can often be treated topically and is usually not a worrisome infection In preterm infants, or other medically complex infants, candida can be invasive and can cause late-onset neonatal sepsis Therefore, in the appropriate setting, blood cultures, urine cultures, evaluation of the CSF, ophthalmologic examination, echocardiogram, renal ultrasound, and systemic antifungal therapy are needed Candidal Diaper Dermatitis See Chapter 66 Rash: Bacterial and Fungal Infections/Rash: Maculopapular Candidal diaper dermatitis is the most characteristic of the diaper rashes (see below for a more detailed discussion of diaper dermatitis) The skin in the diaper area has clusters of erythematous papules and pustules that coalesce into an intensely red confluent rash with sharp borders ( Fig 69.5 ) Beyond these