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Erythema Toxicum Neonatorum

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Erythema Toxicum Neonatorum, Erythema Toxicum

  • See Also
  1. Newborn Skin Exam
  • Epidemiology
  1. Incidence: 30-70% of all infants
  2. More common in term infants (birth weight >2500 grams)
  3. Most common pustular dermatitis in newborns
  • Symptoms
  1. Newborn Rash with flea-bitten appearance
  2. Occurs 24 hours to 2 weeks after birth
    1. Typically onset in first 4 days of life, but not present at birth
  3. Lesions fade in 1 week (may recur in first few weeks of life)
    1. Typically resolves after 4 days
  • Signs
  1. Flea-Bitten Appearance
    1. Small white Pustules on red base
  2. Characteristics
    1. Follicular, yellowish-hued, papulovesicular lesions
    2. Starts as Macule or Papule
    3. Develops Pustules later
    4. Lesions sorrounded by irregular, large red base
  3. Size: Lesions are 1 to 3 mm in diameter
  4. Lesions are NOT grouped
    1. Contrast the grouped lesions in Neonatal HSV
  5. Distribution
    1. Involved areas: Face, trunk, and proximal arms, and legs
    2. Spared areas: Palms and soles
  6. No associated organ involvement
    1. Contrast with Neonatal HSV (e.g. Hepatomegaly)
  • Labs
  1. Vesicles contain Eosinophils on Gram Stain or wright stain
  2. Negative culture
  3. Complete Blood Count
    1. Differential with increased Eosinophils
  • Differential Diagnosis
  1. See Neonatal Pustules and Vessicles
  2. Neonatal HSV
  • Associated Conditions
  1. Transient Neonatal Pustular Melanosis
    1. Similar condition seen in children with darker complexion
    2. Pustules without surrounding erythema
  • Management
  1. No management needed for this benign dermatitis
  2. Resolves spontaneously in 1 to 2 weeks without scarring
  • References
  1. Claudius and Behar in Herbert (2020) EM:Rap 20(8): 5-7
  2. Liu (2005) Dermatology 210:269-72 [PubMed]
  3. Snyder (2024) Am Fam Physician 109(3): 212-6 [PubMed]