Newborn Toxic Erythema

What is it toxic erythema of the newborn?

Toxic erythema of the newborn (also known as toxic erythema and neonatal toxic erythema) is common and benign condition seen in newborns. It affects up to half of all full-term newborns, but is less common in premature newborns. Not known sex or racial predilectionAlthough it has been suggested that it may be poorly recognized in babies with darker skin types.

Clinical characteristics of toxic erythema of the newborn.

Most cases of toxic erythema in the newborn begin in the first days after birth, although the onset may be up to two weeks of age.

Newborn toxic erythema is evident as various combinations of erythematous macules (flat red patches) papules (small bumps) and pustules. the eruption typically increases and decreases over several days and is unusual for an individual injury persist for more than a day.

Newborn toxic erythema often begins on the face and spreads to affect the trunk and extremities. Palms and soles are generally not affected.

The baby is fine otherwise.

Newborn Toxic Erythema

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Newborn Toxic Erythema

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Newborn Toxic Erythema

How is the diagnosis of toxic erythema of the newborn made?

The diagnosis of toxic erythema of the newborn is usually made for clinical reasons. Histology of the skin biopsy samples taken from flat patches show a diffuse infiltrate of eosinophils and neutrophils (inflammatory cells) at the top dermis; of papules shows a eosinophilic infiltration about hair follicle, and of pustular injury sample peripheral subcorneal pustules filled predominantly with eosinophils.

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How toxic newborn erythema arises is unknown. Several theories have been proposed including that it is a reaction to mechanical and thermal stimuli (heat), an "allergic" reaction, or a mild form of graft vs host disease.

Although the toxic erythema of the newborn is benign and does not require treatment, several differential diagnoses should be considered. These include:

  • Infections (folliculitis, impetigo, listeriosis, congenital cutaneous candidiasis, herpes simplex, chickenpox, and cytomegalovirus)
  • Transient neonatal pustular melanosis
  • Infantile acropustulosis
  • Miliaria rubra
  • Eosinophilic pustulosis (Childish Ofuji syndrome)

  • Incontinentia pigmenti
  • Omenn syndrome
  • Self-healing histiocytosis.

These are generally recognized by clinical features, although in some cases the diagnosis may be aided by a Tzanck smear or skin biopsy.