Search

A 54-year-old patient was evaluated because of fever shortly after she had started treatment of a BRAF-mutated melanoma with BRAF- and MEK-inhibitors. Diffuse hyperpigmentation of the skin was noted as an incidental finding. She also had darkly coloured urine. This hyperpigmentation was most likely the result of diffuse cutaneous melanosis secondary to advanced melanoma. This complication results from the release of melanin or its precursor molecules into the systemic circulation. Although diffuse cutaneous melanosis is commonly regarded as an ominous prognostic sign, this patient has so far responded well to targeted therapy.

We present a neonate with transient neonatal pustular melanosis, a benign skin rash seen in 0.2-2.2% of white neonates and in 4-5% of black neonates. Vesicopustular lesions are present at birth, the lesions rupture in 24-48 hours leaving hyperpigmented macules. These slowly fade in 3-10 weeks.

Four neonates with vesicopustular skin eruptions, 1 girl and 3 boys, were diagnosed with feeding blisters, bullous impetigo, erythema toxicum neonatorum and transient neonatal pustular melanosis, respectively. The neonate with bullous impetigo was treated with antibiotics; the remaining neonates were not treated. The neonate with transient neonatal pustular melanosis developed hyperpigmentation, whereas the other neonates recovered without sequelae. Skin lesions in neonates are common and frequently cause parental concern. Most causes of neonatal pustular and vesicular skin eruptions are benign and transient. However, some skin lesions must be recognised and treated rapidly. Therefore it is important to identify these neonatal skin eruptions based on a thorough history of the mother and child and clinical presentation. Skin culture may be helpful in some cases.

A 50-year-old woman complained of nausea, diarrhoea, tiredness and dizziness five weeks after a visit to Egypt. She was deeply tanned with hyperpigmentation on the metacarpophalangeal joints, palm of hand creases and buccal mucosa, due to Addison's disease.