Neonatal Miliaria Pustulosa-A Case Series

Miliaria pustulosa is a noninfectious, transient skin eruption of pustules overlying erythematous plaques secondary to obstruction of eccrine glands. There are very few case reports in the literature detailing miliaria pustulosa in neonates. When presenting in neonates, its similarity to life-threatening infections may cause diagnostic confusion. By differentiating this condition from similar presentations, unnecessary treatments and tests in this population may be avoided.

Retrospective review of the medical records of nine neonates presenting with a pustular eruption diagnosed as miliaria pustulosa. Patients were seen at a children's hospital in Chicago, IL, USA; cases were selected by investigator recall.

In this case series, miliaria pustulosa presents in nine neonates as clusters of eruptive pustules with resolution or significant improvement noted after an average of 2.6 days (range 1-5 days). The average age was 4.6 days (range 1-10 days old) and the average gestational age was 34.7 weeks (range 26.3-40.1 weeks). All patients had pustular outbreaks in areas occluded by swaddling, clothes, or adhesive. Seven patients had geometric lesions that were underlying sites of intravenous (IV) site adhesive or electrocardiogram (EKG) leads.

The consistent morphological features of this pustular eruption at sites of skin occlusion and the transient course in the setting of an otherwise well-appearing infant are strongly suggestive of the diagnosis of miliaria pustulosa. It is important for clinicians to be familiar with this benign presentation and to differentiate it from other neonatal pustular eruptions to minimize invasive tests and treatments in this vulnerable population.