Core Dermatology Diagnoses / CategoriesInflammatory

Neonatal cephalic pustulosis

Author: Deputy Editor: Faculty Reviewer:

Publish date: Posted on
Last updated: October 21, 2023

Keywords #

neonatal cephalic pustulosis
neonatal acne

Diagnosis #

Neonatal cephalic pustulosis is a common pustular skin eruption that occurs on the face of neonates (0-6 weeks). It was previously referred to as “neonatal acne;” its newer nomenclature helps distinguish it from infantile acne, which often occurs at 3-4 months of age. Neonatal cephalic pustulosis is not caused by stimulation of the sebaceous gland. The currently proposed mechanism is an inflammatory reaction to the yeast species Malassezia, though the relationship is poorly understood. [1]

Key Concepts #
  • Neonatal cephalic pustulosis is a pustular eruption on the face and scalp of neonates.
  • It was previously described as “neonatal acne”.
  • It is common and self-limiting.
Epidemiology #

Neonatal cephalic pustulosis affects approximately 10-20% of infants, but possibly up to 66%.[2] Evidence suggests that M. sympodialis triggers the severe form of common cephalic pustulosis.[3]

Clinical Features #
  • Inflammatory papules and pustules, without comedones (which helps distinguish it from true acne).
  • Characteristically only present on the face, and occasionally the scalp, of a neonate.
  • Lesions are not follicularly based (vs true infantile acne).
Differential Diagnoses #
  • Milia
  • Erythema toxicum
  • Herpes simplex virus
  • Eosinophilic pustular folliculitis (EPF)
  • Scabies

    • Miliaria rubra

    Infantile acne

    Staphylococcal folliculitis

Diagnostic Workup #

The diagnosis of neonatal cephalic pustulosis is usually clinical. Direct examination of a pustule smear with potassium hydroxide can show mycotic elements and culture may show Malessezia.[4] Direct microscopy and culture of the pustular contents can be used to rule out other infectious diagnoses. A Wright stain would show mostly neutrophils. Eosinophils, rather than neutrophils, would be present in other similarly appearing diagnoses (e.g., erythema toxicum neonatorum).[4]

Treatment #

Most cases of neonatal cephalic pustulosis are self-resolving, often clearing after 3-4 months without scarring. Soap and gentle cleansers can be used and occlusive oils and lotions should be avoided. Application of topical antifungal agents (e.g., ketoconazole cream) can be used for more moderate cases.

Slide Viewer #
https://utahderm.med.utah.edu/image-viewer/
References #
  1. Ayhan M, Sancak B, Karaduman A, Arikan S, Sahin S. Colonization of neonate skin by Malassezia species: relationship with neonatal cephalic pustulosis. J Am Acad Dermatol.2007 Dec;576:1012-8. doi: 10.1016/j.jaad.2007.02.030. Epub 2007 Sep 24. PMID: 17889963.
  2. Bernier V, Weill FX, Hirigoyen V, Elleau C, Feyler A, Labrèze C, Sarlangue J, Chène G, Couprie B, Taïeb A. Skin colonization by Malassezia species in neonates: a prospective study and relationship with neonatal cephalic pustulosis. Arch Dermatol. 2002 Feb;1382:215-8. doi: 10.1001/archderm.138.2.215. PMID: 11843642.
  3. Niamba P, Weill FX, Sarlangue J, Labrèze C, Couprie B, Taïeb A. Is Common Neonatal Cephalic Pustulosis Neonatal Acne Triggered by Malassezia sympodialis? Arch Dermatol. 1998;1348:995–998. doi:10.1001/archderm.134.8.995
  4. Reginatto FP, Villa DD, Cestari TF. Benign skin disease with pustules in the newborn. An Bras Dermatol. 2016;912:124-134. doi:10.1590/abd1806-4841.20164285
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