Erythema Toxicum
Erythema Toxicum Neonatorum (ETN)
A common, benign, self-limiting inflammatory skin condition affecting newborns, characterized by erythematous macules, papules, and pustules. Despite its concerning appearance, it represents a physiological neonatal phenomenon.
Key Points
- Completely benign condition
- No systemic involvement
- Self-limiting within 5-7 days
- No treatment required
- No long-term sequelae
Epidemiological Characteristics
Prevalence
- Overall Incidence:
- 30-70% of term newborns
- More common in term than preterm infants
- Higher incidence in first-born infants
- Demographic Patterns:
- No gender predilection
- Affects all racial groups equally
- More common in newborns >2500g birth weight
Timing
- Onset:
- 24-72 hours after birth (most common)
- Can appear at birth (rare)
- May develop up to 2 weeks of age
- Duration:
- Individual lesions: 24-48 hours
- Overall condition: 5-7 days
- Rarely persists beyond 2 weeks
Clinical Features
Morphology
- Primary Lesions:
- Erythematous macules (2-3 mm)
- Yellowish-white papules (1-2 mm)
- Pustules (1-3 mm) surrounded by erythema
- Wheals or urticarial plaques (occasional)
- Evolution Pattern:
- Initial erythematous macules
- Progress to papules/pustules
- Resolution without scarring
- New lesions may appear as others resolve
Distribution
- Common Sites:
- Trunk (most common)
- Proximal extremities
- Face
- Buttocks
- Spared Areas:
- Palms
- Soles
- Mucous membranes
- Genitalia (usually)
Associated Features
- General:
- No systemic symptoms
- Normal temperature
- Normal feeding
- No irritability
- Behavioral:
- Does not appear to cause discomfort
- No sleep disturbance
- Normal activity level
Diagnostic Approach
Clinical Diagnosis
- Primary Diagnostic Tools:
- Characteristic appearance
- Typical age of onset
- Absence of systemic symptoms
- Normal vital signs
- Supporting Features:
- Term infant
- Normal birth history
- No maternal risk factors
Laboratory Studies
- Wright Stain (if performed):
- Numerous eosinophils (>50%)
- No bacteria present
- Sterile culture if obtained
- Note: Laboratory studies typically unnecessary
Differential Diagnosis
Infectious Conditions
- Bacterial:
- Staphylococcal pustulosis
- Listeria monocytogenes infection
- Group B streptococcal infection
- Viral:
- Neonatal herpes simplex
- Varicella
- Fungal:
- Candidiasis
Other Neonatal Conditions
- Benign:
- Transient neonatal pustular melanosis
- Miliaria
- Infantile acropustulosis
- Neonatal cephalic pustulosis
- Concerning:
- Langerhans cell histiocytosis
- Incontinentia pigmenti
- Eosinophilic pustular folliculitis
Management Approach
Initial Assessment
- History:
- Birth history
- Maternal infections
- Onset and progression
- Associated symptoms
- Physical Examination:
- Complete skin examination
- General assessment
- Vital signs
Treatment
- General Measures:
- Parental reassurance
- Education about benign nature
- Normal bathing and skin care
- Avoid topical treatments
- Monitoring:
- Observe for expected resolution
- Watch for new concerning symptoms
- Follow-up if needed
Complications & Special Considerations
Rare Presentations
- Unusual Features:
- Prolonged duration (>2 weeks)
- Recurrent episodes
- Atypical distribution
- Special Populations:
- Preterm infants
- Low birth weight babies
- Multiple gestations
When to Worry
- Red Flags:
- Systemic symptoms
- Poor feeding
- Lethargy
- Fever or hypothermia
- Vesicular lesions
- Purulent discharge
Disclaimer
The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.
