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].

• Fever

  The acute disease is often associated with fever, malaise, and arthralgias. [medical-dictionary.thefreedictionary.com]

  When to call the doctor for newborn rash Call your doctor if your baby has additional symptoms, like being extra fussy, not feeding well, or has a fever. [babycenter.com]

  Call your doctor if your baby has a rash and is also fussy, not feeding well, or has a fever. Date reviewed: September 2016 [kidshealth.org]

  The mother had been followed in prenatal clinic, the only illness being a "cold," 1 month prior to delivery, with apparent low-grade fever, malaise, and coryza of 3 to 4 days' duration. [jamanetwork.com]

• Hypothermia

  […] of newborn P80.0 Cold injury syndrome P80.8 Other hypothermia of newborn P80.9 Hypothermia of newborn, unspecified P81 Other disturbances of temperature regulation of newborn P81.0 Environmental hyperthermia of newborn P81.8 Other specified disturbances [icd10data.com]

  Signs of systemic toxicity, including hypothermia or hyperthermia, lethargy, and irritability, are not associated with erythema toxicum neonatorum. [dermaamin.com]

  The occurrence of this dermatosis in the newborn period is thought to be related to the susceptibility of fat to become necrotic in the presence of trauma, asphyxia, hypothermia or a combination of these factors. [7] Histopathologic examination of the [ijdvl.com]

• Hyperthermia

  P83.1 ICD-10-CM Codes Adjacent To P83.1 P80 Hypothermia of newborn P80.0 Cold injury syndrome P80.8 Other hypothermia of newborn P80.9 Hypothermia of newborn, unspecified P81 Other disturbances of temperature regulation of newborn P81.0 Environmental hyperthermia [icd10data.com]

  Signs of systemic toxicity, including hypothermia or hyperthermia, lethargy, and irritability, are not associated with erythema toxicum neonatorum. [dermaamin.com]

  Transitory hyperthermia It is caused by the process of overheating and dehydration, which is common during the 3-5th day of life, characterized by an elevated body temperature till ≥ 38.5–39.5 oC. [eknygos.lsmuni.lt]

• Pallor

  […] anomalies Antenatal/perinatal event Papyraceous fetus or placental infarct Trauma Infection Toxoplasmosis, rubella, cytomegalovirus, herpes Drugs Methimazole/carbimazole Neonatal colour Harlequin colour change, presenting as reddening of the lower half and pallor [racgp.org.au]

• Constitutional Symptom

  Mild constitutional symptoms such as fever,malais,myalgia and arthralgia may precede the appearance of the eruption.The disease is self-limiting. Fig.224f. Erythema nodosum (Erythema nodosum was discussed in the previous chapters). [drmhijazy.com]

• Heart Failure

  Failure Treatment study.CONCLUSIONS: Increased UACR is common in patients with heart failure, including non-diabetics. [read.qxmd.com]

  How to Choose A Nursing Home Relaxation Aim of Relaxation General Advice for Relaxation Types of Relaxation Preparation for Relaxation Techniques of Relaxation Common Disease Hypertension Diabetes Mellitus Arthritis Heart Failure Erectile Dysfunction [myhealth.gov.my]

• Hydrops Fetalis

  […] originating in the perinatal period P83 ICD-10-CM Diagnosis Code P83 Other conditions of integument specific to newborn 2016 2017 2018 2019 Non-Billable/Non-Specific Code Type 1 Excludes congenital malformations of skin and integument ( Q80 - Q84 ) hydrops [icd10data.com]

• Erythema

  Histopathology of erythema toxicum neonatorum. Arch Dermatol. 1960 Oct. 82:586-9. [Medline]. Luders D. Histologic observations in erythema toxicum neonatorum. Pediatrics. 1960 Aug. 26:219-24. [Medline]. [emedicine.medscape.com]

  Synonym(s) Erythema neonatorum allergicum; Erythema toxic of newborns; Erythema toxicum neonatorum; Neonatal erythema; Newborn erythema; Newborn exanthema; Toxic erythema of newborns; toxic erythema of the newborn; Toxic erythema of the newborn; Urticaria [altmeyers.org]

  ABSTRACT Toxic erythema is a common benign dermatological condition in newborns, it appears in the first 48 hours of life. It is usually spontaneously resolved. [medigraphic.com]

  Erythema toxicum neonatorum is characterized by macular erythema, papules, vesicles, and pustules, and it resolves without permanent sequelae. [1] See the image below. [emedicine.com]

  […] and proliferative diseases / cysts / milia / erythema toxicum neonatorum Symptoms Asymptomatic, Diagnosis erythema toxicum neonatorum Dark skin N Pregnancy N Immuno-suppression N erythema toxicum neonatorum Member Rated 0 Patient case no. 638 Date added [dermquest.com]

• Eruptions

  We describe a 10-day-old term infant who presented to the emergency room with an acute pustular eruption. Laboratory tests and clinical outcome confirmed the diagnosis of erythema toxicum neonatorum. [ncbi.nlm.nih.gov]

  They should be reassured regarding the benign, self-limited, asymptomatic nature of this and other eruptions. [17] Review the clinical features with parents before they go home. [emedicine.medscape.com]

  Erythema toxicum is a benign rash common to newborns, which has an appearance that at times makes its diagnosis quite difficult, for it mimics the characteristic rash produced by a systemic staph infection, i.e. erythematous maculopapular eruptions. [lib.uiowa.edu]

  The conditions in the complex are characterized by the sudden onset of a reddened macular, bullous, papular, or vesicular eruption, the characteristic lesion being the iris, bull's eye, or target lesion, which consists of a central papule with two or [medical-dictionary.thefreedictionary.com]

• Skin Lesion

  The clinical lesions referred to as erythema toxicum neonatorum are known to localize at pressure sites. The skin lesions correct as maternal and placental hormone influence weakens. The entity occurs in 31 to 72% of white infants. [ncbi.nlm.nih.gov]

  However, recent studies have failed to prove the presence of maternal cells in skin lesions. [momjunction.com]

  Increased expression of HMGB-1 in the skin lesions of erythema toxicum. Pediatr Dermatol. 2007 Sep-Oct. 24(5):474-82. [Medline]. Marchini G, Lindow S, Brismar H, et al. [emedicine.medscape.com]

  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, trunk, proximal limbs, and buttocks but may even involve the genitalia. [symptoma.com]

• Skin Disease

  Benign skin disease with pustules in the newborn. An Bras Dermatol. 2016; 91 (2): 124-134. doi: 10.1590/abd1806-4841.20164285. Morgan AJ, Steen CJ, Schwartz RA, Janniger CK. Erythema toxicum neonatorum revisited. Cutis. 2009;83 (1):13-16. [medigraphic.com]

  Fölster-Holst R, Höger P (2010) Pustular skin diseases of the newborn. JDDG 7: 569-579 Hansen LP et al (1985) Erythema toxicum neonatorum with pustulation versus transient neonatal pustular melanosis. [altmeyers.org]

  Based on Lever's Histopathology of the Skin, Ninth Edition, this full-color atlas presents an algorithmic pattern recognition approach to differential diagnosis of skin diseases. [books.google.de]

  While the causes of ETN are unknown, the disease occurs as a small yellow-white bump on the skin, which looks like small blisters or fluid-filled bags on the newborn’s skin. [asterhospitals.in]

• Skin Rash

  […] the rash may lead to other skin infections. [asterhospitals.in]

  Erythema toxicum neonatorum (ETN), also known as newborn rash, is a common skin rash that affects many newborns. It affects anywhere from 30 to 70 percent of newborn babies. [healthline.com]

  The rash settles spontaneously, leaving normal skin. Of course, some babies develop dry skin, eczema or other skin problems but these are not related to ETN. [patient.info]

  The condition is of unclear etiology, it's more often seen in term infants than in premature ones, and it's characterized by generalized skin rash, evanescent macules, papules, and pustules in an otherwise well and healthy child, that resolve with no [symptoma.com]

• 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]

• 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]

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

  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]

• Fussiness

  When to call the doctor for newborn rash Call your doctor if your baby has additional symptoms, like being extra fussy, not feeding well, or has a fever. [babycenter.com]

  Call your doctor if your baby has a rash and is also fussy, not feeding well, or has a fever. Date reviewed: September 2016 [kidshealth.org]

  Your baby seems floppy, fussy, or very drowsy. related articles want to learn more? thank an awesome doctor this Doctor's Day! [childrensdayton.org]

  Your baby seems floppy, fussy, or very drowsy. Reviewed by: Mary L. Gavin, MD Date Reviewed: Jan 1, 2022 [akronchildrens.org]

• Irritability

  Definition (NCI) An inflammatory skin condition in the diaper area that may be caused by irritation of infection. [fpnotebook.com]

  Signs of systemic toxicity, including hypothermia or hyperthermia, lethargy, and irritability, are not associated with erythema toxicum neonatorum. [dermaamin.com]

  But if the baby has a fever, the rash is really red, it spreads across the baby’s body, or your baby is irritable or not acting like themselves, it’s time to go see your doctor. [todaysparent.com]

  The patient is not febrile during this period and signs such as lethargy or irritability are absent. [symptoma.com]

  In the pediatric population, irritant dermatitis is more commonly seen than allergic dermatitis. Irritant dermatitis is an inflammation of the skin caused by exposure to irritants such as soaps, saliva, citrus juice, bubble baths, or detergents (1). [hawaii.edu]

• Lethargy

  The patient is not febrile during this period and signs such as lethargy or irritability are absent. [symptoma.com]

  Signs of systemic toxicity, including hypothermia or hyperthermia, lethargy, and irritability, are not associated with erythema toxicum neonatorum. [emedicine.medscape.com]

  Excessive tiredness (lethargy). Fever. Rash that bleeds. Rash that lasts longer than two weeks. A note from Cleveland Clinic Erythema toxicum neonatorum is a skin condition that affects newborns. ETN is common and usually goes away within two weeks. [my.clevelandclinic.org]

  The condition does not cause other signs of systemic toxicityiXToxic effects seen on different parts of the body rather than specific or single organs. such as fever, low temperature, irritability, or lethargy. [momjunction.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.

• Albuminuria

  Heart Failure Importance: Only 1 class of glucose-lowering agents-sodium-glucose cotransporter 2 (SGLT2) inhibitors-has been reported to decrease the risk of cardiovascular events primarily by reducingSeptember 1, 2017: JAMA CardiologyAssociations of albuminuria [read.qxmd.com]

• 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]

No treatment is needed. Erythema toxicum usually goes away on its own within a couple of weeks, with all symptoms gone by the time the baby is 1 to 4 months old. Don't try to pop any of the bumps or use ointments or baby oil on them. [babycenter.com]

Erythema toxicum neonatorum resolves spontaneously without treatment. [ijdvl.com]

Treatment The large red splotches usually disappear without any treatment or changes in skin care. Outlook (Prognosis) The rash usually clears within 2 weeks. It is often completely gone by age 4 months. [limamemorial.org]

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

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

Prognosis The prognosis is excellent with lesions resolving within 7-14 days. There are no residual sequelae. [ncbi.nlm.nih.gov]

Expectations (prognosis) The rash usually clears within 2 weeks. It is usually completely gone by age 4 months. Calling your health care provider Discuss the condition with your health care provider during a routine examination if you are concerned. [indiatoday.in]

Its etiology still remains obscure: some reaction of the skin of the newborn in adapting to its new environment is the favorite hypothesis to date. [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]

Currently, there are no clear epidemiological data, reporting incidences from 3.7% to 72%, so we aimed to identify the epidemiological characteristics of toxic erythema in newborns, treated at Hospital Angeles Pedregal. [medigraphic.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.medscape.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 The condition has been known throughout the ages and was described by ancient Mesopotamian physicians [ 2 ]. [patient.info]

Children and newborn skin care and prevention. An Bras Dermatol. 2011; 86 (1): 102-110. doi: 10.1590/s0365-05962011000100014. Lund C, Kuller J, Lane A, Lott JW, Raines DA. Neonatal skin care: the scientific basis for practice. [medigraphic.com]

Prevention How can I prevent erythema toxicum neonatorum? There’s no way to prevent erythema toxicum neonatorum. The good news is that the condition doesn’t cause any harm to your baby. Usually, your baby’s skin heals within two weeks. [my.clevelandclinic.org]

Photo credit: Centers for Disease Control and Prevention (CDC) Signs and symptoms of newborn rash It looks like small white or yellow "pimples" sometimes surrounded by red skin. [babycenter.com]

In fact a prompt diagnosis is crucial to prevent the superinfection of the patient lesions, as well as epidemic outbreaks. Vuoi citare questo contributo? L'accesso è riservato agli abbonati alla rivista che si siano registrati. [medicoebambino.com]

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.