Erythema toxicum neonatorum usually appears after the age of 3 days and within the first two weeks of life, but they may rarely occur slightly before or later [1] [2]. Manifestations consist of macular erythema, papules, pustules, and vesicles. Particular skin changes resolve by themselves in several minutes to hours, leaving no sequelae [3]. As old lesions disappear, new ones appear and the total duration of erythema toxicum neonatorum is from five days to two weeks. The patient is not febrile during this period and signs such as lethargy or irritability are absent. Mucosal involvement is almost always absent and, when present, the physician should consider herpes simplex infection or candidiasis, especially if present in the mother [4]. Once the disease is resolved, recurrence is infrequent but mild episodes are possible before the sixth week of life.

The skin lesions with an erythematous halo spread centripetally. They are usually absent in the palmar and plantar areas while the lesions are most often found on the face [5], trunk, proximal limbs, and buttocks but may even involve the genitalia [6]. Their size is variable, they are blanchable, and have irregular margins.

Caucasian infants born after a long labor by vaginal delivery, who have a higher birth weight and are born at a higher gestational age are more likely to develop erythema toxicum neonatorum and manifestations tend to have a longer duration. Newborns that receive infant formulas, those born in the summer or autumn whose mothers are younger than 30 years are also at a higher risk [7].

• Cerebral Palsy

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• Increased Birth Weight

  There is no racial or sexual predilection, but there is an increased frequency among infants with increased birth weight and gestational age. Recurrence has been reported during the first two weeks. [healthzene.com]

• Suggestibility

  This process may possibly be integral in developing the new immune system. [7] The high frequency of eosinophilia suggests an allergic basis, leading some authors to suggest that erythema toxicum neonatorum may be an immediate hypersensitivity reaction [emedicine.com]

  This process may possibly be integral in developing the new immune system. 14 The high frequency of eosinophilia suggests an allergic basis, leading some authors to suggest that erythema toxicum neonatorum may be an immediate hypersensitivity reaction [dermaamin.com]

  A suggested viral or allergic nature could not be confirmed by adequate agent or antigen isolation respectively. [ncbi.nlm.nih.gov]

  ETN predominantly affects the hair-bearing areas of the skin, and this suggests the potential involvement of the hair follicle. This seems to be supported by the observed increase in the number of mast cells around the hair follicles. [news-medical.net]

• Breast Engorgement

  P83.0 Sclerema neonatorum P83.1 Neonatal erythema toxicum P83.2 Hydrops fetalis not due to hemolytic disease P83.3 Other and unspecified edema specific to newborn P83.30 Unspecified edema specific to newborn P83.39 Other edema specific to newborn P83.4 Breast [icd10data.com]

Clinical examination and attentive history inquiry are key tools for erythema toxicum neonatorum diagnosis and further investigations are usually unnecessary. A complete blood count may reveal increased eosinophil numbers. The histological evaluation of intralesional content shows the presence of eosinophils and neutrophils [4] [8]. If eosinophils are absent or a systemic disease is suspected, bacterial, viral, and fungal cultures are required. A potassium hydroxide preparation may confirm or exclude candidiasis. If cultures are proven negative and doubt still persists, a skin biopsy should be performed. In the case of erythema toxicum neonatorum, this method will highlight the presence of dermal edema and perivascular inflammatory infiltrate. The root sheath of the hair follicle may also be invaded by eosinophils while pustules are filled with the eosinophil-rich material [9]. In a severely ill child, blood cultures are indicated in order to exclude sepsis. Herpes virus infection can also be ruled out using fluorescent antibody testing or a Tzanck preparation.

• Polyps

  […] fetalis not due to hemolytic disease P83.3 Other and unspecified edema specific to newborn P83.30 Unspecified edema specific to newborn P83.39 Other edema specific to newborn P83.4 Breast engorgement of newborn P83.5 Congenital hydrocele P83.6 Umbilical polyp [icd10data.com]

• Lymphocytic Infiltrate

  Lesions are usually more confluent than those seen in erythema toxicum and demonstrate lymphocytic infiltrate on Wright stain. [healthzene.com]

It usually lasts several days and clears up without treatment. Updated by: Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. [nlm.nih.gov]

ETN doesn’t require treatment. No changes in your baby’s skin care routine are necessary. Many harmless skin conditions can affect your newborn baby, including ETN. [healthline.com]

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Treatment for erythema toxicum Your baby doesn’t need any special treatment because the erythema toxicum rash is harmless and not contagious, and it goes away by itself after a week or so. [raisingchildren.net.au]

Treatment of erythema toxicum No treatment is needed. Erythema toxicum usually goes away on its own within a couple of weeks, with all symptoms completely gone by the time the baby is 1 to 4 months old. [babycenter.com]

Prognosis The prognosis is excellent. The lesions typically resolve within 2 weeks, and no cutaneous or systemic sequelae are generally observed. This is a benign, asymptomatic, self-limited skin condition with no known sequelae. [emedicine.medscape.com]

Treatment and prognosis The diagnosis of ETN is usually made on clinical grounds. Histological tests done from skin biopsies may show inflammatory cell and eosinophilic infiltrates, but this is not required. [news-medical.net]

Abstract Erythema toxicum neonatorum is a common finding of unknown etiology affecting healthy newborn children, particularly those born at term. It is seen in the first days of life, but rarely at birth. [ncbi.nlm.nih.gov]

Etiology of toxic erythema. Erythema toxicum neonatorum. Am J Dis Child. 1963 Sep. 106:306-9. [Medline]. Bassukas ID. [emedicine.com]

Pathophysiology The underlying mechanism of erythema toxicum neonatorum (ETN) is unknown, although various hypotheses have been described. [5] Etiology The underlying pathophysiology is uncertain. [emedicine.medscape.com]

Epidemiologic study of the predisposing factors in erythema toxicum neonatorum. Dermatology. 2005. 210(4):269-72. [Medline]. Monteagudo B, Labandeira J, Cabanillas M, Acevedo A, Toribio J. [emedicine.com]

[…] erythema toxicum neonatorum Member Rated 0 Patient case no. 638 Date added 01 January 1990 Patient details Age Baby / infant Localisation Head / face / forehead Primary Lesions Papule / erythematous Pustule / follicular Erythema Pathophysiology tumors [dermquest.com]

Pathophysiology The underlying mechanism of erythema toxicum neonatorum (ETN) is unknown, although various hypotheses have been described. [5] Etiology The underlying pathophysiology is uncertain. [emedicine.medscape.com]

Pathophysiology Activation of the immune system has been implicated as a potential cause of ETN. [news-medical.net]

The use of lotions to treat the rash, excessive or too vigorous washing of the baby, or rubbing or breaking the pustules associated with ETN should be scrupulously avoided, to prevent secondary skin infections. [news-medical.net]

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs [emedicine.medscape.com]

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1. Kanada KN, Merin MR, Munden A, et al. A Prospective Study of Cutaneous Findings in Newborns in the United States: Correlation with Race, Ethnicity, and Gestational Status Using Updated Classification and Nomenclature. J Pediatr.2012;161(2):240-245
2. Reginatto FP, Villa DD, Cestari TF. Benign skin disease with pustules in the newborn. An Bras Dermatol.2016;91(2):124-134.
3. Schwartz RA, Janniger CK. Erythema toxicum neonatorum. Cutis. 1996;58(2):153-155.
4. Monteagudo B, Labandeira J, Cabanillas M, et al. Prospective Study of Erythema Toxicum Neonatorum: Epidemiology and Predisposing Factors. Pediatr Dermatol. 2012;29(2):166-168.
5. Mahajan VK, Sharma NL. Erythema toxicum neonatorum. Indian Pediatr.2010;47(9):793.
6. Maffei FA, Michaels MG, Wald ER. An unusual presentation of erythema toxicum scrotal pustules present at birth. Arch Pediatr Adolesc Med. 1996;150(6):649-650.
7. Liu C, Feng J, Qu R, et al. Epidemiologic study of the predisposing factors in erythema toxicum neonatorum. Dermatology. 2005;210(4):269-272.
8. Van Praag MC, Van Rooij RW, Folkers E, et al. Diagnosis and treatment of pustular disorders in the neonate. Pediatr Dermatol. 1997;14(2):131-143.
9. Marchini G, Ulfgren AK, Lore K, et al. Erythema toxicum neonatorum: an immunohistochemical analysis. Pediatr Dermatol. 2001;18(3):177-187.