Erythema neonatorum P83.1

Authors: Prof. Dr. med. Peter Altmeyer, Alexandros Zarotis

Last updated on: 07.08.2022

Synonym(s)

Erythema neonatorum allergicum; Erythema toxic of newborns; Erythema toxicum neonatorum; Neonatal erythema; Newborn erythema; Newborn exanthema; Toxic erythema of newborns; toxic erythema of the newborn; Toxic erythema of the newborn; Urticaria neonatorum

History
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First mentioned by Netlinger, 1472; Leiner, 1912

Definition
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Aetiopathogenetically unexplained, self-limiting exanthema that occurs in about 50% of mature newborns, typically on the 2nd day of life (not congenital).

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Dermatology

Lichen planus erosivus mucosae

Mostly severe and chronic erosive variant of the Lichen planus mucosae with mostly extensive, red, painful ...

Etiopathogenesis
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Unexplained; mechanical or thermal stimuli are discussed. Various findings (expression of the antimicrobial peptide LL-37) suggest a microbial stimulus that has not yet been further defined.

Manifestation
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Occurs 12-48 hours after birth; in about 30-50% of mature newborns. Not in children under 2500 g. No gender affinity.

Localization
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Generalized, often beginning in the face, spreading to the trunk, buttocks and proximal extremities, recess of the palmae and plantae.

Clinical features
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12-48 hours after birth, 3-4 days of extremity exanthema with blurred, mostly washed-out erythema, on which about 0.05 to 0.1 cm large, non follicular papules or (sterile) pustules or blisters develop. No impairment of the general condition; no itching.

Histology
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The cytological smear from pustules yields predominantly eosinophilic granulocytes.

Histologically there is eosinophilic dermatitis and folliculitis with subcorneal abscess formation. Furthermore: folliculitis and perifolliculitis with numerous eosinophilic leucocytes.

Differential diagnosis
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Diaper dermatitis; Miliaria; Incontinentia pigmenti; Transitory neonatal pustular melanosis; Candidosis; Scabies; Syphilis connata.

Therapy
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Wait; spontaneous healing usually within 2-3 days. If necessary symptomatically with lotio alba.

Progression/forecast
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Spontaneous healing usually within 7-10 days.

Note(s)
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Transitory neonatal pustular melanosis is considered a variant of the erythema neonatorum.

Literature
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Fölster-Holst R, Höger P (2010) Pustular skin diseases of the newborn. JDDG 7: 569-579
Hansen LP et al (1985) Erythema toxicum neonatorum with pustulation versus transient neonatal pustular melanosis. Dermatologist 36: 475-477
Leiner C (1912) On dyspeptic exanthema and dermatitis of early infancy. F. Deuticke, Leipzig
Marchini G (2002) The newborn infant is protected by an innate antimicrobial barrier: peptide antibiotics are present in the skin and vernix caseosa. Br J Dermatol 147: 1127-1134
Marchini G et al (2001) Erythema toxicum neonatorum: an immunohistochemical analysis. Pediatr Dermatol 18: 177-187.
Marchini G et al (2003) AQP1 and AQP3, psoriasin, and nitric oxide synthases 1-3 are inflammatory mediators in erythema toxicum neonatorum. Pediatr Dermatol 20: 377-384
Mengesha YM et al (2002) Pustular skin disorders: diagnosis and treatment. Am J Clin Dermatol 3: 389-400.
Nanda S (2002) Analytical study of pustular eruptions in neonates. Pediatr Dermatol 19: 210-215
Roques E et al (2022) Erythema Toxicum. 2022 Mar 15. in: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing PMID: 29261957.
Schwartz RA et al (1996) Erythema toxicum neonatorum. Cutis 58: 153-135