epstein pearls

Epstein Pearls

Alexander K. C. Leung, MD, and Benjamin Barankin, MD

A 2-week-old infant presented with whitish lesions on the roof of her mouth (Figure). Her mother worried that this might be thrush. The infant was born at term to a 25-year-old primigravida following an uncomplicated pregnancy and vaginal delivery. The infant was breastfed and supplemented with vitamin D, and the neonatal course was uneventful. On examination, there were a few pearly white nodules in the median palatine raphe. A diagnosis of Epstein pearls was made, and the parents were reassured of the benign nature of the condition. 

Clinically, Epstein pearls present as pearly white or whitish-yellow papules/nodules on the roof of the mouth. The condition was first described in 1880 by Alois Epstein and now bears his name.1 Epstein pearls are caused by entrapped epithelium during palatal fusion. Histologically, they are keratin-containing cysts lined by stratified squamous epithelium. Epstein pearls are seen in approximately 80% of newborn infants and are more common in Caucasian infants.2,3 In one study, Epstein pearls were more prevalent in infants born to multigravida mothers.2 Longer gestation and higher birth weight were found to be independent risk factors.2

Typically, Epstein pearls are seen in the median palatal raphe at the junction of the hard and soft palate.3 In infants with cleft palates, the lesions are located at the margins of the palatal shelves.3 Lesions can be solitary or, more commonly, multiple, and they tend to cluster. The size of the lesions varies from 1 to 3 mm in diameter. On palpation, larger lesions can be appreciated when the infant is sucking on the examiner’s finger. Epstein pearls are asymptomatic and do not cause problems with feeding. 

Epstein pearls usually resolve spontaneously by 3 months of age.3 As such, treatment is not necessary. 

Alexander K. C. Leung, MD, is a clinical professor of pediatrics at the University of Calgary and a pediatric consultant at the Alberta Children’s Hospital in Calgary, Alberta, Canada.

Benjamin Barankin, MD, is a dermatologist and the medical director and founder of the Toronto Dermatology Centre in Toronto, Ontario, Canada.


1. Epstein A. Über Epithelperlen in der. Mundhöhle neugeborener Kinder.
Z Heilkd. 1880;1:59.

2. Gupta P, Faridi  MMA, Batra M. Physiological skin manifestations in twins: association with maternal and neonatal factors. Pediatr Dermatol. 2011;28(4):387-392.

3. Richard BM, Qiu CX, Ferguson MWJ. Neonatal palatal cysts and their morphology in cleft lip and palate. Br J Plast Surg. 2000;53(7):555-558.