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Erythema Toxicum

Last updated June 21, 2022

Reviewed by: Lester Fahrner, MD

Approved by: Krish Tangella MD, MBA, FCAP

Erythema Toxicum is a non-cancerous (benign) skin condition that is usually seen in newborns.


What are the other Names for this Condition? (Also known as/Synonyms)

  • Erythema Toxicum Neonatorum
  • Toxic Erythema of the Newborn

What is Erythema Toxicum? (Definition/Background Information)

  • Erythema Toxicum is a non-cancerous (benign) skin condition that is usually seen in newborns
  • ‘Erythema’, a word derived from Greek, means redness, while ‘neonatorum’ refers to the neonatal period (first 28 days following birth of the child)
  • Erythema Toxicum is a common and benign condition affecting about 50% of all babies born full-term. It is however, not very common in premature infants. The cause of Erythema Toxicum has not yet been identified
  • It may either appear within the first few hours of birth, or a day after, and could be present for many days. Although it does not cause any harm, it may be worrisome for the new parents
  • The prognosis of this condition is very good. Erythema Toxicum frequently resolves on its own within a few months of onset and no treatment may be required

Who gets Erythema Toxicum? (Age and Sex Distribution)

  • 50% of newborns infants will get Erythema Toxicum; the condition usually appears between the ages of 3-14 days. A majority of cases are reported in babies more than 2 days old
  • In some cases, it may appear in the first few hours following birth
  • Full-term babies (those born between 37 and 40 weeks of gestation) are more commonly affected than premature or preterm babies
  • There is no known ethnic or racial predilection identified. However, scientists believe that the condition tend to be unnoticed in dark-skinned infants
  • Erythema Toxicum is more common in male infants affecting 1 in 2 male infants; while it affects only 1 in every 3 female infants

What are the Risk Factors for Erythema Toxicum? (Predisposing Factors)

  • Currently, there are no known risk factors for Erythema Toxicum

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Erythema Toxicum? (Etiology)

The exact cause of Erythema Toxicum development remains unknown.

  • However, some scientists believe that mechanical and thermal (heat) factors, allergies, or a less severe form of graft versus host disease could act as stimuli for the condition to arise
  • Studies also suggest that it could be a normal inflammatory reaction or a normal response of the body’s immune system
  • Other studies have suggested it to be a newborn child’s immune response (immunity) to harmless microorganisms, which may have penetrated the infant’s skin at or just after birth

Breastfeeding or formula feeding do not have any effect on development of this condition.

What are the Signs and Symptoms of Erythema Toxicum?

The affected infant is usually healthy. The signs and symptoms of Erythema Toxicum are mostly related to the skin rashes that appear. These include:

  • A rash exhibiting small, yellow-to-white colored papules (raised spots), which have pustule-like spots (pus- filled) or vesicles (fluid-filled blisters), which are surrounded by red skin, is the most commonly seen symptom
  • When the raised spot is pressed, it may appear to have become pale and faded
  • The rashes (or lesions) may change rapidly by disappearing and re-appearing in different areas of the body over hours and days. Individual lesions usually go away within a day
  • The pustules and vesicles may be many in number or just a few, and could also vary in size
  • It is mostly seen on the face and the middle of the body, but can sometimes be seen on the upper arms and thighs. It is rarely seen on the palms or the soles. It may even be present in larger numbers on only some areas of the body
  • The rash could occur within a few hours of birth, more commonly after 2 days and can start as late as 2 weeks, resolving on its own within a week’s time
  • The rash could also recur, up until the infant is 6 weeks old, though such recurrences are mild and very rare

How is Erythema Toxicum Diagnosed?

The following tests and procedures may be used to diagnose Erythema Toxicum:

  • Thorough evaluation of the individual’s family (medical) history and a complete physical examination including skin
  • During history taking the physician may want to know the following:
    • When the rash began and whether it has increased or decreased in size, numbers, and frequency, and the area in the body where it first appeared
    • List of prescription medications the infant is currently taking (if any)
    • Family history of skin diseases, birth moles, birth marks, skin conditions, etc.
  • The diagnosis is typically made based on history and examination of the rash by the physician. Testing is usually unnecessary, unless there is an undetermined cause for the rash and also when the infant is unwell
  • In some cases, Tzanck smears for herpes virus infections, Wright staining for visualization of eosinophils, or skin biopsies have also aided in a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Erythema Toxicum?

Erythema Toxicum is a benign and harmless condition. There are no short-term or long-term complications observed. The rashes disappear spontaneously on their own leaving behind an unblemished skin.

How is Erythema Toxicum Treated?

Erythema Toxicum is a benign condition that resolves spontaneously without leaving any effects on the baby. Even at the time of the rash, babies do not generally experience any rash-related discomfort or pain. Thus, parents need not be overly worried or concerned about the condition.

  • It is recommended to avoid repeated soapy washes, as they could easily dry out the baby’s delicate skin
  • The rash should not be picked or squeezed or the fluids (if present) be drained out. Doing so could lead to a skin infection
  • No special skin care is required, and thus, there is no need to discontinue the use of skin care products (previously used), provided these are fragrance-free and meant for newborn babies

How can Erythema Toxicum be Prevented?

Currently, there are no known prevention methods for Erythema Toxicum.

What is the Prognosis of Erythema Toxicum? (Outcomes/Resolutions)

  • No treatment or special skin care is required for Erythema Toxicum, since the rash usually disappears on its own
  • Typically within 2 weeks the rashes start to clear-up and are completely gone, when the child is about 4 months of age

Additional and Relevant Useful Information for Erythema Toxicum:

Please visit our Skin Care Health Center for more physician-approved health information:

http://www.dovemed.com/healthy-living/skin-disorders/

What are some Useful Resources for Additional Information?


References and Information Sources used for the Article:


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Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: May 28, 2015
Last updated: June 21, 2022