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Pediatric Erythema Toxicum Workup

  • Author: Elizabeth Arrington, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Nov 04, 2014
 

Laboratory Studies

See the list below:

  • Because of the distinctive appearance of erythema toxicum neonatorum (ETN), laboratory studies are typically not indicated. Microscopic examination of a skin lesion using a Wright stain reveals numerous eosinophils. Peripheral blood studies may also reveal a circulating eosinophilia.
  • Because of the distinctive appearance of the lesions, the nontoxic status of the neonate, and the evanescent nature of the eruption, the diagnosis is usually clear. If any doubt about the diagnosis exists, further studies are needed to evaluate for an underlying bacterial, viral, or fungal disease.
    • A simple Gram stain or Wright stain should reveal evidence of a sterile pustule populated primarily by eosinophils. The presence of neutrophils suggests an infectious cause.
    • Results from a direct slide (fluorescent antibody testing) of a smear or a Tzanck preparation should be negative for herpes simplex (or, rarely, varicella-zoster virus) because these are reasonably sensitive tests for these particular viruses.
    • A simple potassium hydroxide preparation can be performed to evaluate for fungal infection, such as congenital cutaneous candidiasis.
    • Blood cultures and appropriate workup for neonatal sepsis from group B Streptococcus, Listeria, Escherichia coli, and other pathogens should be considered in the appropriate context of illness in a neonate.
    • A skin biopsy may be necessary if the diagnosis is unclear.
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Histologic Findings

See the list below:

  • Hyperkeratosis, follicular plugging, and accumulation of primarily eosinophils with some neutrophils in the follicular epithelium
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Contributor Information and Disclosures
Author

Elizabeth Arrington, MD Resident Physician, Department of Dermatology, University of South Florida College of Medicine

Elizabeth Arrington, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Coauthor(s)

Neil Alan Fenske, MD Chairman, Department of Dermatology and Cutaneous Surgery, Professor, Department of Dermatology and Cutaneous Surgery, Department of Pathology and Cell Biology, Department of Oncologic Sciences, Medical Director, Health Cosmetic and Laser Center, University of South Florida College of Medicine

Disclosure: Received none from Abbvie for speaking and teaching; Received none from Valeant for speaking and teaching.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Kevin P Connelly, DO Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University School of Medicine; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center

Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, American Osteopathic Association

Disclosure: Nothing to disclose.

References
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  18. Marchini G, Stabi B, Kankes K, et al. AQP1 and AQP3, psoriasin, and nitric oxide synthases 1-3 are inflammatory mediators in erythema toxicum neonatorum. Pediatr Dermatol. 2003 Sep-Oct. 20(5):377-84. [Medline].

  19. Stone OJ. High viscosity of newborn extracellular matrix is the etiology of erythema toxicum neonatorum: neonatal jaundice?: hyaline membrane disease?. Med Hypotheses. 1990 Sep. 33(1):15-7. [Medline].

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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.
 
 
 
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