Erythema toxicum neonatorum: Difference between revisions
(Expand with concise EM-focused content: palms/soles sparing, HSV differential, Wright stain with eosinophils) |
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==Background== | ==Background== | ||
{{Skin anatomy background images}} | {{Skin anatomy background images}} | ||
* | *Most common benign rash of newborns, occurring in ~50% of full-term neonates | ||
* | *Self-limited condition lasting ~1-2 weeks | ||
*Etiology unclear; thought to be related to activation of the innate immune system at hair follicles | |||
*Onset typically 24-72 hours after birth, but can appear up to 2 weeks of age | |||
*Incidence declines with decreasing gestational age (rare in preterm infants) | |||
==Clinical Features== | ==Clinical Features== | ||
[[File:Erythema toxcium.png|thumb|Erythema toxicum]] | [[File:Erythema toxcium.png|thumb|Erythema toxicum]] | ||
*Erythematous [[rash|macules]] | *Erythematous [[rash|macules]], papules, and pustules on a blotchy erythematous base | ||
*Spares palms and soles | *Distribution: face, trunk, proximal extremities | ||
* | *'''Spares palms and soles''' (key distinguishing feature) | ||
*Lesions are evanescent — appear, fade, and reappear in different locations over hours to days | |||
*Infant is well-appearing, afebrile, feeding normally | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Neonatal rashes DDX}} | {{Neonatal rashes DDX}} | ||
*'''Key differentials to consider:''' | |||
**Neonatal [[herpes simplex virus|HSV]]: clustered vesicles, ill-appearing infant, fever | |||
**[[Staphylococcal scalded skin syndrome]]: widespread erythema, skin tenderness, desquamation | |||
**Transient neonatal pustular melanosis: pustules on non-erythematous base, present at birth | |||
==Evaluation== | ==Evaluation== | ||
* | *Clinical diagnosis in a well-appearing neonate | ||
*If diagnosis uncertain: Wright stain of pustule contents shows '''eosinophils''' (pathognomonic) | |||
*No labs, cultures, or imaging needed if classic presentation | |||
==Management== | ==Management== | ||
*No treatment necessary | *No treatment necessary — reassurance to parents | ||
*Resolves spontaneously within 1-2 weeks without sequelae | |||
==Disposition== | ==Disposition== | ||
* | *Discharge with parental reassurance | ||
*No follow-up needed unless atypical features | |||
==See Also== | ==See Also== | ||
*[[Neonatal | *[[Neonatal rashes]] | ||
*[[Transient neonatal pustular melanosis]] | |||
==References== | |||
<references/> | |||
[[Category:Dermatology]] | [[Category:Dermatology]] | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
Latest revision as of 01:26, 21 March 2026
Background
- Most common benign rash of newborns, occurring in ~50% of full-term neonates
- Self-limited condition lasting ~1-2 weeks
- Etiology unclear; thought to be related to activation of the innate immune system at hair follicles
- Onset typically 24-72 hours after birth, but can appear up to 2 weeks of age
- Incidence declines with decreasing gestational age (rare in preterm infants)
Clinical Features
- Erythematous macules, papules, and pustules on a blotchy erythematous base
- Distribution: face, trunk, proximal extremities
- Spares palms and soles (key distinguishing feature)
- Lesions are evanescent — appear, fade, and reappear in different locations over hours to days
- Infant is well-appearing, afebrile, feeding normally
Differential Diagnosis
Neonatal Rashes
- Acne
- Atopic dermatitis
- Candidiasis
- Contact dermatitis
- Diaper dermatitis
- Erythema toxicum neonatorum
- Impetigo
- Mastitis
- Milia
- Miliaria
- Mongolian spots
- Omphalitis
- Perianal streptococcal dermatitis
- Psoriasis
- Pustular melanosis
- Seborrheic dermatitis
- Sucking blisters
- Tinea capitis
- Key differentials to consider:
- Neonatal HSV: clustered vesicles, ill-appearing infant, fever
- Staphylococcal scalded skin syndrome: widespread erythema, skin tenderness, desquamation
- Transient neonatal pustular melanosis: pustules on non-erythematous base, present at birth
Evaluation
- Clinical diagnosis in a well-appearing neonate
- If diagnosis uncertain: Wright stain of pustule contents shows eosinophils (pathognomonic)
- No labs, cultures, or imaging needed if classic presentation
Management
- No treatment necessary — reassurance to parents
- Resolves spontaneously within 1-2 weeks without sequelae
Disposition
- Discharge with parental reassurance
- No follow-up needed unless atypical features