Erythema Toxicum Neonatorum In Newborns: Symptoms & Treatment

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Toxic erythema of the newborn, 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 condition (1). The condition does not cause other signs of systemic toxicity 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

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 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 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 lesions 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.

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 infiltration. Eosinophils are a type of white blood cells. It was suggested that the allergic reaction 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 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).

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 rashes 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).

  • Pyoderma
  • Congenital candidiasis
  • Staphylococcal folliculitis
  • Neonatal Sepsis
  • Acne neonatorum (baby acne)
  • Neonatal varicella
  • Miliaria (heat rash)
  • Herpes
  • Transient neonatal pustular melanosis (TNPM)
  • Incontinentia pigmenti
  • Infantile acropustulosis

Treatment For Erythema Toxicum

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.

Frequently Asked Questions

1. Can erythema toxicum spread?

Erythema toxicum in babies usually starts on the face and may spread to the arms, legs, and torso. However, the condition is not contagious and does not spread from one person to another (5).

2. Are there any long-term effects of erythema toxicum in newborns?

Erythema toxicum has been found to have a good prognosis and no long-term complications in the child. However, a link between erythema toxicum and eosinophilic esophagitis (allergic condition of the esophagus) may be present (1).

Erythema toxicum in newborns is a self-limiting condition that could appear from the first six days of life to two weeks after birth. The precise cause of this skin condition is unknown. However, it is considered an allergic response of undetermined etiology. Most babies get transient rashes and are generally well otherwise. Experts advise letting the condition run its course as the rashes usually self-heal without causing skin damage or scars. Nonetheless, consulting a doctor for all skin-related problems during the neonatal period is vital to ensure the baby is safe and healthy!

Key Pointers

  • Erythema toxicum is a common, non-concerning skin condition seen in newborns and appears as rashes of different types.
  • These lesions can result from factors such as an allergic reaction or the action of microbes near the hair follicles.
  • The doctors can identify the condition from its significant rashes and usually let them heal on their own within the normal 14-day period.

References:

MomJunction's articles are written after analyzing the research works of expert authors and institutions. Our references consist of resources established by authorities in their respective fields. You can learn more about the authenticity of the information we present in our editorial policy.
1. Erythema Toxicum; U.S. National Library of Medicine
2. Etiology of Toxic Erythema; Erythema Toxicum Neonatorum; JAMA Pediatrics; JAMA Network
3. Toxic Erythema of the Newborn; DermNet NZ
4. Newborn Skin: Part I, Common Rashes; American Academy of Family Physicians
5. Erythema toxicum; Raining Children, Australia
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Dr Bisny T. Joseph

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 3+ 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 made... more

Dr. Neema Shrestha

(MD)
Dr. Neema Shrestha is a pediatrician with a special interest in the field of neonatology. 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 and Fellowship in Neonatology from Sir Ganga Ram Hospital, New Delhi in... more