The n e w e ng l a n d j o u r na l of m e dic i n e

Images in Clinical Medicine

Stephanie V. Sherman, M.D., Editor

Neonatal Cephalic Pustulosis

A B

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N Engl J Med ####;###:fpage-lpage.

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A
Wei‑Cheng Fang, M.D. n 8-day-old boy was evaluated for a sudden-onset pustular rash
Li‑Wen Chiu, M.D. that had developed while he was being monitored for neonatal abstinence
Kaohsiung Medical University Hospital syndrome in the neonatal intensive care unit. He had been born at term by
Kaohsiung, Taiwan spontaneous vaginal delivery. There was no maternal history of genital herpes.
kthrn​.­chiu@​­gmail​.­com Physical examination revealed multiple, scattered, erythematous papules and pus-
This article was published on August 5, tules measuring up to 5 mm in diameter on the scalp, face, neck, and upper chest
2023, at NEJM.org. (Panel A). There were no comedones or involvement of the palms or soles. A com-
plete blood count and C-reactive protein level were normal. A bacterial culture and
Tzanck smear of the contents of a pustule were negative. A potassium hydroxide
preparation of a pustule scraping (Panel B) showed fungal spores (arrow) and hyphae
(arrowhead). A diagnosis of neonatal cephalic pustulosis was made. Neonatal ce-
phalic pustulosis is a common neonatal pustular eruption that appears in infants
during the first few weeks of life. The pathophysiology is not well known but may
relate to an overgrowth of malassezia species. Most cases resolve spontaneously,
and topical antifungal treatment may hasten the resolution. Three days after the
patient began a course of topical antifungal cream, the rash had resolved.
DOI: 10.1056/NEJMicm2301685
Copyright © 2023 Massachusetts Medical Society.

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