Pediatric Erythema Toxicum Workup

  • Author: Elizabeth Arrington, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Apr 16, 2012
 

Laboratory Studies

  • 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.
Next

Histologic Findings

  • Hyperkeratosis, follicular plugging, and accumulation of primarily eosinophils with some neutrophils in the follicular epithelium
Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

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

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: SkinMedica Honoraria Speaking and teaching; Amgen Honoraria Speaking and teaching; Graceway Pharmaceuticals Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; LEO Pharmaceuticals Honoraria Speaking and teaching; PharmaDerm Honoraria Speaking and teaching

Specialty Editor Board

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, and American Osteopathic Association

Disclosure: Nothing to disclose.

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, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

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

Disclosure: Nothing to disclose.

Merrily P M Poth, MD  Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences

Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

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

Disclosure: Nothing to disclose.

References

  1. Kanada KN, Merin MR, Munden A, Friedlander SF. A Prospective Study of Cutaneous Findings in Newborns in the United States: Correlation with Race, Ethnicity, and Gestational Status Using Updated Classification and Nomenclature. J Pediatr. Apr 10 2012;[Medline].

  2. Tarang G, Anupam V. Incidence of vesicobullous and erosive disorders of neonates. J Dermatol Case Rep. Dec 12 2011;5(4):58-63. [Medline]. [Full Text].

  3. Lehndorff H. Bartholomaeus Metlinger. A fifteenth century pediatrician. Arch Pediatr. Jul 1951;68(7):322-33. [Medline].

  4. Eitzman DV, Smith RT. The nonspecific inflammatory cycle in the neonatal infant. AMA J Dis Child. Mar 1959;97(3):326-34. [Medline].

  5. Bassukas ID. Is erythema toxicum neonatorum a mild self-limited acute cutaneous graft-versus-host-reaction from maternal-to-fetal lymphocyte transfer?. Med Hypotheses. 1992;38:334-338. [Medline].

  6. Carr JA, Hodgman JE, Freedman RI, Levan NE. Relationship between toxic erythema and infant maturity. Am J Dis Child. Aug 1966;112(2):129-34. [Medline].

  7. Keitel HG, Yadav V. Etiology of Toxic Erythema. Erythema Toxicum Neonatorum. Am J Dis Child. Sep 1963;106:306-9. [Medline].

  8. Saracli T, Kenney JA Jr, Scott RB. Common skin disorders in the newborn Negro infant. Observations based on the examination of 1,000 babies. J Pediatr. Mar 1963;62:359-62. [Medline].

  9. Liu C, Feng J, Qu R. Epidemiologic study of the predisposing factors in erythema toxicum neonatorum. Dermatology. 2005;210(4):269-72. [Medline].

  10. Morgan AJ, Steen CJ, Schwartz RA, Janniger CK. Erythema toxicum neonatorum revisited. Cutis. Jan 2009;83(1):13-6. [Medline].

  11. [Guideline] New York State Department of Health. Dermatologic manifestations. New York State Department of Health. 2004;[Full Text].

  12. O'Connor NR, McLaughlin MR, Ham P. Newborn skin: Part I. Common rashes. Am Fam Physician. Jan 1 2008;77(1):47-52. [Medline].

  13. Duperrat B, Bret AJ. Erythema neonatorum allergicum. Br J Dermatol. Aug-Sep 1961;73:300-2. [Medline].

  14. Hurwitz S. Erythema toxicum. In: Clinical Pediatric Dermatology. 1993: 13-14.

  15. Johnson BL, Honig PJ, Jaworsky C. Erythema toxicum neonatorum. In: Pediatric Dermatopathology. 1994: 82.

  16. Marchini G, Nelson A, Edner J, et al. Erythema toxicum neonatorum is an innate immune response to commensal microbes penetrated into the skin of the newborn infant. Pediatr Res. Sep 2005;58(3):613-6. [Medline].

  17. 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. Sep-Oct 2003;20(5):377-84. [Medline].

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

  19. Taylor WB, Bondurant CP Jr. Erythema neonatorum allergicum; a study of the incidence in two hundred newborn infants and a review of the literature. AMA Arch Derm. Nov 1957;76(5):591-4. [Medline].

 
Previous
Next
 
A 5-day-old newborn with erythematous papules with surrounding indistinct blotchy erythema visible on the abdomen. Image courtesy of Jining I. Wang, MD.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.