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Erythema Toxicum Neonatorum

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Clinical Summary

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Erythema toxicum neonatorum is a benign, self-limited eruption of unknown etiology that occurs in up to 70% of term newborns characterized by discrete, small, erythematous macules or patches up to 2 to 3 cm in diameter with 1- to 3-mm firm pale yellow or white papules or pustules in the center. The trunk is predominantly involved. This rash usually presents within the first 24 to 72 hours of life. The distinctive feature of erythema toxicum is its evanescence or disappearance with each individual lesion usually disappearing within 2 or 3 days. New lesions may occur during the first 2 weeks of life. The neonate should appear well and lack any systemic signs of illness other than occasional peripheral eosinophilia. Wright-stained slide preparations of the scraping from the center of the lesion demonstrate numerous eosinophils. The differential diagnosis includes transient neonatal pustular melanosis, newborn milia, miliaria, neonatal herpes simplex, bacterial folliculitis, candidiasis, and impetigo of the newborn.

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Emergency Department Treatment and Disposition

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As this condition is self-limiting, no therapy is indicated in the setting of a well-appearing newborn with normal activity and appetite. Parents can be educated and reassured about the evanescence of the rash. In cases where impetigo, Candida, or herpes infections are suspected, a smear from the center of the lesion and bacterial and viral cultures may be necessary to make a final diagnosis.

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Figure 14.1.
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Erythema Toxicum. Newborn infant with diffuse macular rash of erythema toxicum. (Photo contributor: Kevin J. Knoop, MD, MS.)

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Figure 14.2.
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Erythema Toxicum. Close up of lower extremity of a neonate with erythema toxicum. (Photo contributor: Robert W. Hickey, MD.)

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Pearls

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  1. Erythema toxicum is the most common rash of the newborn.

  2. The lesions may present anywhere on the body but tend to spare the palms and soles.

  3. Laboratory evaluation is usually unnecessary.

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Salmon Patches (Nevus Simplex)

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Clinical Summary

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Nevus simplex (salmon patch) is the most common vascular lesion in infancy, present in about 40% of newborns. It appears as a slightly pink to deep scarlet macule or patch on the nape of the neck, the glabella, mid-forehead, or upper eyelids. Lesions generally fade over the first 2 years of life but may become more prominent with crying or straining.

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Emergency Department Treatment and Disposition

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Parental education and reassurance can be helpful, but no treatment is indicated. Pulsed dye laser may be considered for persistent lesions that are cosmetically undesirable.

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Figure 14.3.
Graphic Jump Location

Salmon Patches. Newborn with characteristic salmon patches over his face. ...

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