Toxic Erythema of the Newborn

Newborn skin is special, fragile and with a particular anatomy and physiology. Many neonates have skin lesions, such as erythema toxicity, which in most cases do not require treatment.
Toxic erythema is the most common skin rash in the newborn and affects approximately 20% to 70% of term infants, being very rare in premature infants. Its name tends to scare parents, but it is inaccurate, as no evidence has been found to confirm this toxic nature.
It is a benign inflammatory eruption that was described in 1826. Since its description, it has received different names: toxoallergic rash, neonatal urticaria or “flea bite dermatitis.”

Symptoms

The lesions appear at 24-72 hours of life (some cases from two or three weeks after birth). Its symptoms are the appearance of multiple small papules 1 to 3 cm in diameter. Its most common location is the face, trunk and extremities . It does not affect the palms of the hands or the soles of the feet. The papule evolves into a pustule with a very erythematous or reddish halo. When the lesions are very abundant they can join and form plaques of several centimeters. Each of the lesions persists for only a few hours and then disappears . The rash as a whole can last about 7-10 days, but in some cases it can persist for weeks. Toxic erythema presentsKoebner phenomenon , that is, we can observe the appearance of lesions in areas exposed to friction and minor trauma, such as the rubbing area of the diaper .
Cases of recurrences after the rash has disappeared have been described in the medical literature.

Treatment

It does not require treatment , it does not affect the general or health condition of the newborn, so it is not treated, and it resolves itself in a few days or weeks.
The only precaution is that a correct diagnosis must be made and we must differentiate it from the following entities that do require treatment:

  • Folliculitis : is a bacterial infection caused by Staphyloccocus aureus or Haemophilus influenzae that must be treated with antibiotics.
  • Disseminated herpetic infection . It is a viral infection with serious repercussions on the health status of the newborn that requires admission and treatment .

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