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Vesiculobullous and pustular lesions in the newborn

Josie A Pielop, MD
Section Editors
Moise L Levy, MD
Leonard E Weisman, MD
Morven S Edwards, MD
Deputy Editor
Rosamaria Corona, MD, DSc


Vesicles, bullae, and pustules in the newborn may be caused by infections, congenital disorders, or other diseases. Benign and self-limited disorders, including erythema toxicum neonatorum (picture 1), transient neonatal pustular melanosis (picture 2A-B), and neonatal acne (picture 3), do not require specific therapy. However, certain infections and genetic disorders must be differentiated from these self-limited conditions because treatment may be needed (table 1).

Blistering conditions in the newborn caused by infection or congenital abnormalities are reviewed here. Benign neonatal vesiculopustular and bullous disorders are discussed separately. (See "Benign skin and scalp lesions in the newborn and infant".)


Infection always should be considered as a cause of vesiculobullous or pustular lesions in the newborn. Infectious disorders may be life-threatening and require urgent therapeutic intervention.

Viral infection — A number of viruses can cause vesiculopustular or bullous lesions in the newborn. In most cases, lesions do not appear at birth but rather days to weeks later. Herpes simplex virus (HSV) and varicella-zoster virus (VZV) are the two most common, but cytomegalovirus (CMV) and coxsackieviruses occasionally can induce these types of skin lesions. In the past, variola virus (smallpox) was also in the differential diagnosis. (See "Acquired cytomegalovirus infection in children" and "Enterovirus and parechovirus infections: Clinical features, laboratory diagnosis, treatment, and prevention".)

Herpes simplex — Neonatal HSV infection primarily results from intrapartum exposure to maternal cervical or vaginal lesions, or by an ascending infection, sometimes through apparently intact membranes. Postnatal inoculation also may occur. (See "Genital herpes simplex virus infection and pregnancy" and "Neonatal herpes simplex virus infection: Clinical features and diagnosis", section on 'Clinical manifestations'.)

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Literature review current through: Nov 2017. | This topic last updated: Mar 16, 2016.
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