Erythema Toxicum in Newborns: Should Parents Be Worried?

Newborn babies are known for their soft, smooth skin. That’s why it’s not surprising for parents to immediately worry when they find any form of a rash. However, some rashes are normal and don’t require treatment. One such rash is erythema toxicum. Here’s what you need to know about it.

What Is Erythema Toxicum¹?

Erythema toxicum neonatorum, or toxic erythema of the newborn, is a benign and self-limiting condition (meaning it will go away on its own). It is one of those newborn rashes that do not require treatment.

It has no known cause, although a possible reason is hormonal imbalance during the first 48 hours of life. Erythema Toxicum is common among newborns, and it has no racial or sexual predisposition. In fact, erythema toxicum occurs in about 50% of full-term infants.

How Can Parents Tell If It’s Erythema Toxicum

It’s quite easy to spot toxic erythema in your newborn. One clue is that it develops within 24 to 48 hours after birth. However, in some cases, the rashes may develop as late as 10 days after delivery.

What does toxic erythema look like?

Initially, lesions appear as red blotches that may be macules (flat) or papules (raised). Eventually, they develop into pustules with raised bumps that may have a whitish fluid inside. Note that although the fluid looks like pus, there’s no infection.

Newborns may develop erythema toxicum on their face, chest, back, arms, and legs (save for their palms and the soles of the feet).

Typically, the lesions resolve within 14 days. Recurrence is not common, but still, it is possible. If toxic erythema recurs, it usually happens in the baby’s sixth week.

Are Some Babies More Prone to Toxic Erythema²?

While the exact cause of toxic erythema can be unknown or due to hormonal imbalance, health experts likewise speculate that it has something to do with newborns’ hair follicles.

Newborn babies typically have more hair follicles than adults, and inflammatory cells tend to collect in those follicles. This might also explain why the lesions do not affect the palms and soles of feet (since they do not have hair follicles).

Babies born vaginally, especially in hot, wet climates appear to be more prone to developing rashes. Reports also indicate a positive connection between the length of labor to the occurrence and duration of erythema toxicum.

What Other Conditions Have the Same Symptoms?

Erythema toxicum may be benign, self-limiting, and asymptomatic; however, other conditions cause the same symptoms. Some of these require treatment.

These conditions include:

• Infections, such as folliculitis, congenital cutaneous candidiasis, and impetigo. Remember that any kind of infection requires prompt treatment.
• Heat rash
• Transient neonatal pustular dermatosis, another benign condition that needs no treatment
• Acne neonatorum or neonatal acne

When To Bring Your Newborn to the Doctor

Even though many newborn rashes, like erythema toxicum, are benign, there are times when medical attention is required. How can parents identify if their baby already needs medical help?

First, always bring your baby to their scheduled checkup. That way, the doctor can spot any rash that’s out of the ordinary. The following tips might also help:

• Try firmly rolling a clear glass over the rash. A rash that doesn’t fade when pressed might be indicative of a meningitis rash.
• Monitor other symptoms, such as a cough, sore, watery eyes, or white spots inside their mouth. These might point to measles. Fever can be a sign of an infection.
• Take note of the duration of the rash. If the rashes don’t get better as expected or worsen over time, bring your baby to the doctor.

Learn more about Baby Care here.