Etiology of Toxic Erythema

Abstract

Toxic erythema (erythema toxicum neonatorum) is a dermatosis of the neonatal period. The rash is rarely seen at birth and appears in the first one to six days of life after which time the lesions disappear spontaneously. The appearance of the lesion has been described at length elsewhere, including the histologic aspects.1-5 It seemed of interest to obtain evidence of the possible relationship of toxic erythema to atopy since others have indicated that toxic erythema may have an allergic "basis." 1 Indeed, the lesion looks somewhat like a wheel.This report presents data of the incidence of atopy in the relatives of infants with toxic erythema and in control infants without toxic erythema. A suggestion as to the possible nature of this disorder is offered. MethodThe findings of 208 consecutive newborn Caucasian infants are reported. The infants were completely undressed during the physical examination and examined daily by observers who were experienced in the differential diagnosis of neonatal rashes. Patients with characteristic lesions which appeared any time during the first five days were classified as having toxic erythema.A family history of atopy was obtained from the mother. The presence of any of the following conditions in the immediate relatives was used as evidence of atopy : hay fever, asthma, infantile eczema, or hives. ResultsSixty-two per cent of 208 consecutive new¬ born infants developed toxic erythema, and a family history of atopy was present in 17%. A statistically significant relationship be¬ tween the occurrence of toxic erythema in infants and a family history of atopy was not observed (Table).Patches of erythema can readily be induced in the newborn by applying fairly light pres¬ sure to the skin of the newborn during the

Clinical spectrum of neonatal skin disorders at Hamdard University Hospital Karachi, Pakistan

“…There were 15.59% with nappy rash in this study; Ferahbas A et al [14] reported incidence of 2% this difference may be due to financial reasons, our mothers do not change nappies as frequently as required leading to prolong stool contact resulting in nappy rash. Erythema toxicum neonatrum is the most common pustular dermatitis in newborns a benign condition requiring no intervention, presented in 15.50% of neonates in this study, reported incidence is 21-40% [15,16].…”

An Image for Differential Diagnosis

“…They usually begin at 1 to 2 days of age, but may occur at any time until about the fourth day. [1,2,3] Blotchy erythematous macules 1 to 3 cm in diameter with a 1 to 4 mm central vesicle or pustule are seen in erythema toxicum neonatorum (ETN). Number of lesions can vary from one or two to several hundred.…”

“…The infant appears well, unperturbed by the eruption. Spontaneous recovery usually occurs within 3 to 7 days without any residual pigmentation [3]. A smear of the central vesicle or pustule contents reveals numerous eosinophils on Wright stain preparations.…”

Maternal cells are not resp for erythema tox neon

“…Marchini et al (5) postulated that ETN may translate an innate immune/inflammatory response to the first colonization of the skin by commensal microbes at birth. Others have proposed that ETN could be considered as a manifestation of atopy, essentially because of the eosinophilic infiltrate (6). Of interest, Bassukas (7) related ETN to a self‐limited acute graft‐versus‐host reaction induced by maternal lymphocytes reacting against the child’s antigens.…”