What is Erythema Toxicum?
Erythema toxicum neonatorum is a type of skin rash seen in babies. It was first noticed way back in the 15th century by a pediatrician named B. Metlinger. It’s thought to be a reaction of the baby’s skin to meconium, which is the baby’s first bowel movement. This condition has had different names throughout history, like erythema populated, erythema dyspepsia, and erythema neonatorum allergicum. However, an Austrian pediatrician called Dr. Karl Leiner gave it its current name, erythema toxicum neonatorum, in 1912.
The rash itself includes small yellowish bumps and spots that are surrounded by an irregular area of red skin. The majority of these rashes are temporary, often disappearing within a few hours, only to show up again in a different spot. Except for the baby’s palms and soles, these skin changes can appear anywhere on the body.
This skin condition usually shows up within the first week after birth and typically goes away within one to two weeks.
What Causes Erythema Toxicum?
Erythema toxicum neonatorum is a harmless skin condition that often affects newborn babies. It appears shortly after birth and goes away on its own without any treatment. This condition is experienced by nearly half to almost three-quarters of all newborn babies who are born full-term.
A study conducted in 1986 found that about 41% of 5387 Japanese newborns had erythema toxicum neonatorum over a ten-year period. However, preterm infants, particularly those weighing less than 2500 grams at birth, are less likely to get this condition.
The skin rash in this condition often contains a large number of eosinophils, a type of white blood cell. Some experts think that this might be due to an allergic reaction.
Risk Factors and Frequency for Erythema Toxicum
Erythema toxicum neonatorum, a skin condition in newborns, does not show a preference for any specific race. However, it seems to occur more frequently in males than females. In a study of 356 newborns in Spain, about 25.3% of them had this condition. Out of these, 61.9% were males, and 38.1% were females. It is very rare for this condition to come back, but there have been a few cases where it returned within the first month of the baby’s life.
Signs and Symptoms of Erythema Toxicum
Erythema toxicum neonatorum is a skin condition in newborns, characterized by various types of skin eruptions. The skin lesions can appear as hard, white or yellow spots about 1 to 3mm in size, often surrounded by a mottled reddish area. Moreover, these lesions might present as a bumpy area surrounded by red skin or a red spot with diffused boundaries. Sometimes, redness in the skin might be the only visible sign. These spots can be few or many, and their distribution can either be gathered in certain areas or scattered all over the body.
Interestingly, the condition appears to have two main variations; a version showing red bumps (papules) and another showing pus-filled bumps (pustules). On the first day, you may see flat red or pink spots within and around the red, bumpy or pus-filled areas. The condition typically begins on the cheeks and quickly spreads to the forehead, the rest of the face, the chest, the trunk, and the limbs. In some cases, the skin over the scrotum can also be involved. As the flat spots blend, a blotchy appearance can result, sometimes resembling an allergic reaction on the trunk. However, the palms and the soles usually remain unaffected, possibly because of the distribution of hair follicles on the body.
Spotting erythema toxicum neonatorum can be challenging in babies with darker skin tones. The red or pink spots are often short-lived but can persist and progress to form bumps. Some bumps can rise above the skin’s surface, especially on the back and the abdomen. It’s rare for these pus-filled bumps to get infected. The condition peaks on the baby’s second day of life, with new spots developing over the next few days as the rash comes and goes. Although the rash can come back in up to 11% of babies, it sometimes takes a few days or even weeks to develop in premature babies. There are no systemic symptoms with this condition, although occasionally, blood tests may show a slight increase in a type of white blood cell called eosinophils, with counts up to 18% reported in some cases.
Testing for Erythema Toxicum
Usually, there’s no need for a lab test to diagnose this condition as doctors can often spot the signs just through an examination. However, in the cases that a test is performed, it may show the presence of eosinophils – a type of white blood cell, in a skin bump that doesn’t show sign of infection.
In some babies, doctors may need to rule out conditions like herpes simplex and varicella-zoster, which are types of viral infections. They may also need to ensure that a fungal infection is not the cause, which can be done using a simple test with a substance called potassium hydroxide.
Treatment Options for Erythema Toxicum
The first step of treatment for this condition is to educate the parents about its nature. It’s important for them to know that the condition is harmless and will go away on its own without leaving any side effects. It’s understandable that seeing a rash can be alarming for parents, so the top priority is to reassure them about the situation and its harmless nature.
What else can Erythema Toxicum be?
Doctors diagnosing erythema toxicum neonatorum, a common newborn rash, might have to consider other similar conditions. These include:
- Sepsis
- Staphylococcal folliculitis
- Acne neonatorum
- Pyoderma
- Congenital candidiasis
- Herpes simplex
- Infantile acropustulosis
- Neonatal varicella (chickenpox)
- Miliaria (heat rash)
- Transient neonatal pustular melanosis
- Incontinentia pigmenti
Some of these conditions are easier to differentiate from erythema toxicum neonatorum. For example, transient neonatal pustular melanosis and incontinentia pigmenti both have distinguishing features and can coexist with the neonatal rash. However, the rashes in these conditions look different and have unique characteristic patterns and cell types. The location of the rashes can also help, such as infantile acropustulosis, which characteristically appears on the feet and hands, unlike erythema toxicum neonatorum. Another differentiating factor could be the type of vesicles (small fluid-filled blisters) associated with the conditions, like in miliaria rubra where vesicles relate to sweat ducts and not hair follicles.
Congenital cutaneous candidiasis, another potential condition, presents with a red rash full of papules (small, raised bumps), pustules (blister or pimple-like sores filled with pus) and vesicles. Unlike erythema toxicum neonatorum, this rash can appear on the palms and soles. Therefore, the thorough examination is vital to make an accurate diagnosis.
What to expect with Erythema Toxicum
The outlook is very good as the lesions usually heal within 7 to 14 days. There are no leftover complications or issues.
Recovery from Erythema Toxicum
Long-term monitoring is needed since a condition called erythema toxicum, a common newborn rash, is associated with eosinophilic esophagitis, a condition that affects the food pipe (esophagus). If children show signs of esophagitis, such as difficulty in swallowing or stomach pain, they should be asked about any rashes they might have had when they were newborns.
