Erythema Toxicum Neonatorum In Newborns: Symptoms & Treatment

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Erythema toxicum in newborns, also called erythema toxicum neonatorum or erythema toxicum, is a benign, transient, and self-limited skin eruption in newborns. Approximately 48% to 72% of term infants develop this skin irritation condition (1). 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.

Read this post to know about the symptoms, causes, diagnosis, and treatment of toxic erythema of the newborn.

Symptoms And Signs Of Erythema Toxicum Of The Newborn

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Erythema toxicum of the newborn may usually begin within the first six days of life. However, some babies may have late onset of the condition at up to two weeks of age. Erythema rash is rarely seen at birth (2). The skin redness and rashes may start on the face and spread to the torso and limbs. Palms and soles are usually spared. In most cases, babies appear well other than the skin rashes.

You may notice any of the following types of skin rashes in toxic erythema of the newborn (3).

• Erythematous macules are red flat skin patches
• Papules are small bumps on the skin
• Pustules are small skin bumps filled with pus or fluid

An irregular reddish wheal can surround yellow pustules and papules. These skin eruptions can wax and wane over several days. It means they may increase or decrease in number, size, or severity over days.

How Long Does It Take For Erythema Toxicum To Go Away?

Most skin lesionsⁱXThe parts of the skin that look different than the skin around them. in toxic erythema are transient or temporary. It may often disappear within a few hours and reappear on other parts of the body other than the soles and palms. Erythema toxicum may resolve within seven to fourteen days from the first day of their appearance. The skin eruptions fade away without leaving any scars.

Ruth Sameke, a mom of a baby girl, shares her experience on her blog of when her little girl suffered from Erythema toxicum, “I had been told that rashes are common in babies and that the rash that will appear on baby May’s cheeks and forehead, but no one told me about the one that would cover her entire face. So imagine the scare I got when I woke up one morning to find baby May’s face covered in blotchy bumps. What broke out on baby May’s face is called Erythema Toxicum Neonatorum. It is mostly common in full-term babies (40/40 weeks). She didn’t scratch or even seem bothered by it; however, it hurt to watch. Within two weeks, it was gone, you would have never known it was once there (ⅰ).’’

Causes Of Toxic Erythema Of The Newborn

The exact cause of toxic erythema of the newborn is unknown. It is considered to be an allergic response since the skin lesions display significant eosinophilic infiltrationⁱXThe build-up of eosinophils (white blood cells) in a tissue or organ that may lead to inflammation or destruction of the tissue. . Eosinophils are a type of white blood cells. It was suggested that the skin allergies could be due to the maternal lymphocytes (a type of white blood cell). However, recent studies have failed to prove the presence of maternal cells in skin lesions.

The absence of skin lesions on non-hair-bearing areas, such as palms and soles, suggests that erythema toxicum could be a response to skin inflammation caused by microbes penetrating the hair follicles. However, more studies are needed to identify the microbes and the mechanism for the development of erythema toxicum neonatorum (1).

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There is no genetic or gender prediction known for erythema toxicum. Premature infants tend to be less likely affected by the condition for unknown reasons.

Diagnosis Of Toxic Erythema Of The Newborn

Doctors can diagnose erythema toxicum based on the clinical features. Characteristics of a neonatal rash and no associated symptoms are key to diagnosis. Skin biopsy could show infiltration of neutrophils and eosinophils in the upper skin. Pustules and papules may also contain these inflammatory cells and are usually located around the hair follicles.

Clinical diagnosis is sufficient in most cases, and no laboratory analysis is ordered. Doctors may often order some tests to rule out similar conditions. Differential diagnosis to toxic erythema of the newborn may include the following conditions (4).

• PyodermaⁱXA rare skin disorder that causes severe ulceration (wounds) of the skin, usually on the legs.
• Congenital candidiasisⁱXA rare condition in newborns usually caused by intrauterine candida infection that leads to rashes, respiratory disorders, and sepsis.
• Staphylococcal folliculitisⁱXfolliculitis: A bacterial infection of the hair follicle that resembles acne and causes itching and discomfort.
• Neonatal SepsisⁱXBlood infection occurring in newborns and babies less than 90 days old.
• Acne neonatorum (baby acne)
• Neonatal varicellaⁱXAbnormalities in the newborn due to the mother getting chickenpox during early pregnancy.
• Miliaria (heat rash)
• HerpesⁱXA skin condition leading to sores and painful blisters on different parts of the body.
• Transient neonatal pustular melanosis (TNPM)ⁱXA benign skin disorder occurring in newborns in which they have pus-filled pustules at birth which burst later.
• Incontinentia pigmentiⁱXA disorder that affects skin, hair, teeth, nails, eyes, and the central nervous system and is characterized by skin lesions in babies.
• Infantile acropustulosisⁱXA condition in which there is a recurrence of itchy pustules on the extremities.

Quick fact

Doctors may advise taking a small amount of fluid from one of the pustules and check it for the presence of viruses, fungi, or bacteria, as they may cause similar rashes (6).

Treatment For Erythema Toxicum

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Erythema toxicum of the newborn does not require any treatment since it fades away within days or weeks without any complications. Doctors may educate the parents about the natural course of this condition and advise them not to apply any OTC creams or other remedies.

Primary care physicians may often refer to pediatric dermatologists to rule out other diagnosis (3). Antifungals and antibacterial creams are only effective in treating newborn rashes caused by fungal infections and bacterial infections.

Quick tip

Avoid over-scrubbing or over-bathing the baby, as it might lead to skin dryness. Keep them clean using mild, fragrant-free soaps (6).

Infographic: Conditions Requiring Medical Attention In Erythema Toxicum Neonatorum

Erythema toxicum neonatorum (ETN) affects newborns during their first two weeks of life and is usually mild. However, contact a pediatrician if you observe any symptoms mentioned in the infographic below. As several skin conditions may have symptoms similar to ETN, early diagnosis can help prevent potential complications.

Illustration: Momjunction Design Team

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Dr. Neema ShresthaMD

Dr. Neema Shrestha is a pediatrician with a special interest in the field of neonatology. She has an overall experience of five years working in the field. Currently working in Kathmandu, Nepal, she completed her MBBS from Kasturba Medical College, Manipal in 2008, Diploma in Child Health from D.Y. Patil University in 2011, MD from Nepal Medical College in 2015...more

Dr Bisny T. JosephMedical Doctor

Dr. Bisny T. Joseph is a Georgian Board-certified physician. She has completed her professional graduate degree as a medical doctor from Tbilisi State Medical University, Georgia. She has around 5 years of experience in various sectors of medical affairs as a physician, medical reviewer, medical writer, health coach, and Q&A expert. Her interest in digital medical education and patient education...more

Rohit GarooBSc, MBA

Rohit Garoo is a writer-turned-editor with over 9 years of experience in content writing, editing, and content marketing. He did his bachelors in Science at St. Xavier's College, Hyderabad, and masters in Business Administration at Osmania University. Also, he holds a certificate in Developmental Psychology from The University of Queensland and loves to expand his knowledge through certifications in various...more

Shinta Liz SunnyM.Tech

Shinta is a biotechnologist who is highly intrigued by science and technology. She holds a master's degree in Biotechnology from Karunya Institute of Technology and Sciences and a PG Diploma in cellular and molecular diagnostics from Manipal University. At MomJunction, Shinta writes on mother and child health and wellness. Previously, she worked as a scientist for three years, involved in developing...more