Neonatal Disease

Erythema toxicum neonatorum is a common benign transient pustular eruption seen in the newborn period.

Erythema toxicum neonatorum occurs more commonly in healthy term infants than in premature and low birth weight infants.

The cause of erythema toxicum neonatorum is unknown.

Erythema toxicum neonatorum lesions appear as “blotchy” macules that develop into superficial pink papules and pustules, taking on a “flea-bitten” appearance.

Macules can coalesce to form large pink patches studded with only a few to hundreds of pustules.

Erythema toxicum neonatorum can occur anywhere on the skin, but the face, arms, buttock, and torso are most frequently involved. The palms and soles are rarely affected.

Overall, erythema toxicum neonatorum can wax and wane with individual lesions appearing to occur in crops. Individual lesions can disappear in hours or last for up to 2 weeks.

There are no signs of systemic illness.

A smear (Wright's or Giemsa's stain) of pustule fluid shows abundant eosinophils with relatively few neutrophils.

For atypical cases, a skin biopsy can be done, showing subcorneal pustules with eosinophils.

Bacterial infection ( Staphylococcus aureus, group B Streptococcus, Pseudomonas aeruginosa, Listeria monocytogenes, Haemophilus influenzae, Klebsiella pneumoniae )

Fungal infection (Candida)

Viral infection (herpes simplex, varicella)

Transient neonatal pustular melanosis

Scabies

Erythema toxicum neonatorum resolves within 3 weeks of life, without any adverse sequelae.