Erythema neonatorum toxicum (ETN) is a skin rash frequently observed in healthy newborns. It is also known as erythema toxicum or toxic erythema of the newborn. This condition affects a significant number of full-term infants, with estimates ranging from 15% to 70% of newborns experiencing it within their first week of life. While its appearance can be concerning for new parents, ETN is a benign and temporary condition that does not cause discomfort for the baby.
Understanding Erythema Neonatorum Toxicum
The rash of erythema neonatorum toxicum typically presents as red blotches, which are flat red patches. These can progress rapidly to small raised bumps, and sometimes tiny pus-filled bumps. The appearance can vary, ranging from a few scattered lesions to many widespread spots, and it is sometimes described as “flea-bitten.”
The rash commonly appears within the first few days after birth, often on day two, though it can manifest as late as two weeks of age. While it can appear almost anywhere on the body, it is most frequently seen on the face, trunk, and limbs. Areas usually spared from this rash include the palms of the hands and soles of the feet, likely because these regions lack hair follicles. Individual lesions may appear and disappear within hours, and the eruption generally waxes and wanes over several days.
Why It’s Not a Cause for Concern
The exact cause of erythema neonatorum toxicum remains unknown. It is widely understood that this rash is not due to an infection, an allergy, or poor hygiene. One hypothesis suggests it may be a response to microbes entering hair follicles as part of the normal immune system development in newborns.
Erythema neonatorum toxicum is a benign and self-limiting condition, resolving on its own. The rash does not cause any discomfort, itching, or pain for the baby, and it does not lead to any long-term health issues or leave scars. It is not contagious.
When to Consult a Doctor
Erythema neonatorum toxicum typically resolves on its own within 5 to 14 days. While recurrences are uncommon, if they do occur, they are usually mild and may appear around the sixth week of life before resolving again. No specific medical treatment is necessary for this rash.
However, medical attention is warranted if the rash is accompanied by other concerning symptoms. Parents should consult a doctor if the baby develops a fever of 100.4°F (38°C) or higher, seems lethargic, is difficult to wake, or is not feeding well. Additionally, if the rash itself appears to be blistering, spreading rapidly, or looks infected, such as having broken skin or surrounding warmth and redness, a healthcare professional should be consulted. These symptoms could indicate a different, potentially more serious condition that requires professional medical evaluation.