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Erythema Toxicum Neonatorum Workup

  • Author: Neil F Gibbs, MD; Chief Editor: William D James, MD  more...
 
Updated: Apr 12, 2016
 

Laboratory Studies

Erythema toxicum neonatorum (ETN) is diagnosed clinically based on history, physical examination, and peripheral smear of intralesional contents.

On a CBC count, eosinophilia are noted in approximately 15% of patients as up to 18% of the total WBC count. Eosinophilia may be more pronounced when the eruption shows a marked pustular component.

A Wright stain performed on intralesional contents will reveal primarily eosinophils. Inflammatory cells are present, with greater than 90% eosinophils and variable numbers of neutrophils.[21, 23]

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Other Tests

If clinical symptoms warrant concern for systemic disease, Giemsa stain fails to show eosinophils, and/or clinical suspicion warrants an evaluation of other diagnoses, perform viral, bacterial, and fungal cultures to exclude herpes simplex virus, varicella, pathogenic bacterial, and yeast infections.

Perform potassium hydroxide preparation to exclude candidiasis.

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Procedures

A skin biopsy is diagnostic but rarely is required for diagnosis.

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Histologic Findings

Histologic examination of macules reveals mild dermal edema with a sparse predominantly perivascular inflammatory infiltrate composed primarily of eosinophils, with small numbers of neutrophils and monocytes. Papules have increased edema and inflammatory infiltrate with involvement of the superficial portion of the pilosebaceous unit. Eosinophilic invasion of the outer root sheath of the hair follicle is noted. Pustules are subcorneal or intraepidermal and are found associated with the pilosebaceous orifice. A variable infiltrate of eosinophils and monocytes may be seen with or without neutrophils in the surrounding dermis.[24, 25, 26]

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Contributor Information and Disclosures
Author

Neil F Gibbs, MD Voluntary Associate Professor, Departments of Pediatrics and Medicine (Dermatology), University of California, San Diego School of Medicine; Residency Program Director, Pediatric Dermatologist, Department of Dermatology, Naval Medical Center, San Diego; Clinical Professor of Dermatology and Clinical Professor of Pediatrics (Secondary), Uniformed Services University of the Health Sciences, Bethesda, Maryland

Neil F Gibbs, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Meghan E Seago, MD Staff Dermatologist, US Naval Hospital Guam

Meghan E Seago, MD is a member of the following medical societies: American Academy of Dermatology, Massachusetts Medical Society, Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Van Perry, MD Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas School of Medicine at San Antonio

Van Perry, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Eleanor E Sahn, MD Director, Division of Pediatric Dermatology, Associate Professor, Departments of Dermatology and Pediatrics, Medical University of South Carolina

Eleanor E Sahn, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Southern Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Trisha C Beute, MD Staff Physician, Department of Dermatology, Naval Medical Center, Portsmouth

Trisha C Beute, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Robert Huff, MD Dermatology, Inc

Robert Huff, MD is a member of the following medical societies: American Academy of Dermatology and Phi Beta Kappa

Disclosure: Nothing to disclose.

Eleanor E Sahn, MD Director, Division of Pediatric Dermatology, Associate Professor, Departments of Dermatology and Pediatrics, Medical University of South Carolina

Eleanor E Sahn, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Southern Medical Association

Disclosure: Nothing to disclose.

References
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A 5-day-old newborn with erythematous papules with surrounding indistinct blotchy erythema visible on the abdomen. Image courtesy of Jining I. Wang, MD.
Yellow pustules, some with evidence of rupture, in a full-term infant at 6 hours of life.
Erythematous blotchy patches localized to the trunk in a neonate.
A Wright-Giemsa stain performed on the contents of a ruptured pustule reveal numerous eosinophils.
 
 
 
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