Neonatal cephalic pustulose B36.8

Kraus 1913; Aractingi et al. 1991

Frequent transient infectious pustulosis of the infant (Chadha A et al. 2019). After a latency of 2-3 weeks after birth, newborns develop acne-like symptoms with the appearance of follicular papulopustules on the face, neck and also on the capillitium without impairment of the general condition.

Frequent occurrence. Malassezia furfur can be detected at birth in 11% of newborns and at the age of 3 weeks in 52% of newborns. Up to 75% of colonized newborns develop pustules of varying severity.

Pityrosporum ovale is a lipophilic yeast that lives saprophytically in areas of the infant rich in sebaceous glands. The pathogens are transmitted from mother to child during and after birth.

The apparitions mainly affect the face, the neck and the capillitium.

After a latency period of 2-3 weeks, an acute, "acneiform pustulose" with tiny, follicular, yellowish pustules and reddened papules occurs in the otherwise clinically inconspicuous newborn in the area of the capillitium, neck and in the seborrhoeic zones of the face. Malassezia furfur is regularly detected from pustule swabs, which can be assessed natively (see below pityriasis versicolor). In contrast to acne infantum, comedones are completely absent.

Microscopic detection of the pathogens in the pustular smear.

• Erythema neonatorum: Occurrence earlier. No pustular formation.
• Miliaria cristallina: No pustular formation. Smallest, water clear vesicles.
• Milia of the newborn: May already be present at birth; no pustules, solid, deep-seated, firm, yellow papules, no acute course; rupture usually after a few weeks.

• A therapy is not necessary, since the disease is self-limiting.
• If treatment is urgently required: Apply 2% ketoconazole cream(Nizoral cream) 2 times/day for 2 weeks on the affected areas.
• Alternatively Ciclopiroxolamine (e.g. Batrafen Gel). Wash mother's head and hair several times with ketoconazole solution.

The apparitions used to be erroneously called "Acne neonatorum" and were thus aetiologically misunderstood. They no longer occur in older infants despite increasing colonisation with Malassezia furfur.

This frequent transient infant dermatosis must be distinguished from Acne neonatorum, the infantile acne(Acne infantum), both of which occur with acne-typical changes (inflammatory papules, pustules, comedones).

1. Ayhan M et al (2007) Colonization of neonate skin by Malassezia species: relationship with neonatal cephalic pustulosis. J Am Acad Dermatol 57:1012-101
2. Bergman JN et al (2002) Neonatal acne and cephalic pustulosis: is malassezia the whole story? Arch Dermatol 138:255-257
3. Bernier V et al (2002) Skin colonization by Malassezia species in neonates: a prospective study and relationship with neonatal cephalic pustulosis. Arch Dermatol 138: 215-218

4. Chadha A et al (2019) Common Neonatal Rashes. Pediatr Ann 48:e16-e22.

5. Crespo Erchiga V, Delgado Florencio V (2002) Malassezia species in skin diseases. Curr Opin Infect Dis 15: 133-142

6. Rapelanoro R et al (1996) Neonatal Malassezia furfur Pustulosis. Arch Dermatol 132: 190-193
7. Zuniga R et al (2013) Skin conditions: common skin rashes in infants.skin conditions: common skin rashes in infants. Skin conditions: common skin rashes in infants. FP Essent 407:31-41.