Erythema toxicum neonatorum

Erythema toxicum neonatorum
Specialty Pediatrics 

Erythema toxicum neonatorum[1] (also known as erythema toxicum,[1] urticaria neonatorum and toxic erythema of the newborn[1]) is a common rash in neonates.[2]:139[3] It appears in up to half of newborns carried to term, usually between day 2–5 after birth; it does not occur outside the neonatal period.

Erythema toxicum is characterized by blotchy red spots on the skin[4] with overlying white or yellow papules or pustules.[5] These lesions may be few or numerous. The eruption typically resolves within first two weeks of life and frequently individual lesions will appear and disappear within minutes or hours. It is a benign condition thought to cause no discomfort to the baby.[4]

Presentation

The rash is composed of small papular lesions, each on a separate reddened base.

Cause

The cause of erythema toxicum is thought to be an activation of the immune system. Some neonates are more sensitive than others and develop erythematous spots all over the body. Another theory is hypersensitivity to detergents in bedsheets and clothing is sometimes suspected, but the connection remains unproven.

It is thought to be a benign condition that causes no discomfort to the infant. The rash will generally disappear spontaneously in about 2 weeks.

Diagnosis

Whilst usually a straightforward diagnosis at times the appearance can raise concern that the rash could be due to herpes simplex; however, the latter generally has a more clustered and vesicular appearance.

In uncertain cases, a scraping of a lesion can be taken and the fluid examined under the microscope. Herpetic lesions will have a positive direct fluorescent antibody test. The fluid from erythema toxicum lesions will show many eosinophils. If blood samples are taken, they may show a high level of circulating eosinophils; however, this is not usually required.

Differential diagnosis may include herpes simplex virus, impetigo, neonatal sepsis, Listeria infection and Varicella (chickenpox) infection. Another important neonatal skin disease, staphylococcal scalded skin syndrome, can be differentiated by the fact that it classically occurs within the first 24 hours after birth (not 2-5 days after) and carries with it a much more severe clinical picture.

Treatment

Because the eruption is transient and self-limiting, no treatment is indicated.

References

  1. 1 2 3 Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0.
  2. James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
  3. Berg FJ, Solomon LM (April 1987). "Erythema neonatorum toxicum". Arch. Dis. Child. 62 (4): 327–8. doi:10.1136/adc.62.4.327. PMC 1778345. PMID 3592724.
  4. 1 2 "Erythema toxicum". Pubmed Health. Retrieved 28 November 2012.
  5. "erythema toxicum" at Dorland's Medical Dictionary
Classification
External resources
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