This is a benign neonatal dermatosis that is most common among African-American infants. The original lesion is a vesiculopustule, which may be present at birth. This small blister quickly ruptures and leaves a typical collarette of superficial scale. In some infants, the pustule and collarette stages seem to occur in utero, and the sole cutaneous manifestations are the typical macules. Lesions of transient neonatal pustular melanosis favor the forehead, neck, chin, and lower back but may be very widespread and may involve the palms and soles. Scraping the base of an unroofed pustule reveals polymorphonuclear leukocytes but no bacteria, pseudohyphae, or multinucleated giant cells. A biopsy of a pustule, which is rarely necessary, shows an intraepidermal collection of polymorphonuclear leukocytes.