Differential Diagnosis for Newborn Rash with Pustules on Face
- Single Most Likely Diagnosis + Erythema Toxicum Neonatorum (ETN): This is a common, benign condition that appears as a rash with pustules on the face and body of newborns, typically within the first few days of life. It is thought to be an allergic reaction and resolves spontaneously.
- Other Likely Diagnoses + Acne Neonatorum: Caused by exposure to maternal androgens, leading to comedones, papules, and pustules, primarily on the face. It usually resolves by 4-6 months. + Milia: Small, white, or yellowish bumps on the nose, chin, and cheeks, due to keratin-filled cysts. They are very common in newborns and typically resolve on their own. + Transient Neonatal Pustular Melanosis: A benign condition characterized by pustules that leave behind hyperpigmented macules. It is more common in darker-skinned infants.
- Do Not Miss Diagnoses + Congenital Syphilis: Although less common, it can present with a rash, including pustules, and is critical to diagnose due to the severe consequences of untreated syphilis. + Herpes Simplex Virus (HSV) Infection: Can cause a vesicular or pustular rash, and neonatal HSV infection is a medical emergency requiring prompt antiviral treatment. + Staphylococcal Scalded Skin Syndrome (SSSS): Caused by staphylococcal toxins, leading to widespread skin exfoliation and can start with localized pustules. It is a serious condition that requires immediate medical attention.
- Rare Diagnoses + Langerhans Cell Histiocytosis: A rare disorder that can present with skin lesions, including pustules, among other systemic symptoms. + Congenital Leishmaniasis: Extremely rare, but can cause skin lesions, including pustules, in newborns, depending on the geographic location and maternal infection status. + Incontinentia Pigmenti: A genetic disorder that can cause skin lesions, including pustules, typically along the lines of Blaschko, and is associated with other systemic manifestations.