Erythema Toxicum Neonatorum

What is erythema toxicum neonatorum?

Erythema toxicum neonatorum (ETN) is a skin condition in newborns. Usually, ETN looks similar to acne. Red patches or small, fluid-filled bumps (pustules) may form on the baby’s face, limbs or chest.

ETN isn’t dangerous and usually goes away on its own. It isn’t painful or uncomfortable for your baby and doesn’t have long-term effects.

Sometimes, people refer to erythema toxicum neonatorum as baby acne. But baby acne is a different condition. It causes similar symptoms but usually lasts longer than ETN.

Who might get erythema toxicum neonatorum?

Any baby can get erythema toxicum neonatorum. It’s more likely to occur if it’s a first pregnancy or if the baby:

• Is born at term.
• Is assigned male at birth (AMAB).
• Has a diet that includes powdered milk substitutes.
• Has a higher birth weight.

Risk for ETN increases if the baby’s birth:

• Is vaginal.
• Lasts many hours.
• Occurs in a wet, hot climate.

Where does the name erythema toxicum neonatorum come from?

Erythema means redness. Neonatorum refers to the neonatal period, when a baby’s less than a month old. Together, the words mean the redness and rash occur in babies soon after birth. The term toxicum can be misleading — the condition isn’t toxic and is harmless to babies.

How common is erythema toxicum neonatorum?

ETN is very common. Almost half of all newborns develop it. ETN is more common in full-term babies than in premature ones.

What causes erythema toxicum neonatorum?

Experts don’t know exactly what causes ETN. Some theories say that babies get ETN because their hair follicles and oil-producing (sebaceous) glands aren’t fully formed yet.

ETN may form because of inflammation and bacteria around hair follicles. Experts think ETN may develop as a response to bacteria. This process could be an important step in immune system development.

What are the symptoms of erythema toxicum neonatorum?

The telltale sign of ETN is small, fluid-filled bumps. Although the fluid in the bumps may look like pus, it doesn’t point to an infection. The bumps may also:

• Disappear and form in new areas over a few hours.
• Get paler when you apply slight pressure to them.

Babies with ETN may also appear to have a skin rash around the bumps. The rash may look like red patches over parts of your baby’s body.

Symptoms usually only show up on parts of the body that have hair follicles, such as the arms, legs, chest or face. The bumps don’t appear on the soles of the feet or palms of the hands.

Symptoms may be present at birth, or they may form a few days after birth. ETN isn’t related to any symptoms that affect other parts of the body (systemic symptoms).

How is erythema toxicum neonatorum diagnosed?

Usually, healthcare providers can diagnose ETN by looking at your baby’s skin. Doctors and midwives are very familiar with the condition.

Sometimes, the provider may take a small sample of fluid from one of the pustules. They may test the fluid in a lab to check for other viruses, fungi or bacteria that could cause a similar but more concerning rash.

If the birthing parent has genital herpes and the baby’s delivered vaginally, there’s a risk that the baby could have herpes simplex. In that case, the baby’s provider may make a Tzanck smear. In a Tzanck smear, the provider uses a small, sharp tool (scalpel) to remove a pustule. A pathologist (doctor specializing in tissue analysis) looks at the sample under a microscope to diagnose or rule out herpes.

How is erythema toxicum neonatorum treated?

Babies don’t need any specific treatment for ETN. The rash and bumps typically go away within five to 14 days of forming and may come back in a few weeks but go away again. Avoid picking at or touching the pustules. Picking at these bumps can lead to a skin infection.

How can I prevent erythema toxicum neonatorum?

There’s no way to prevent erythema toxicum neonatorum. The good news is that the condition doesn’t cause any harm to your baby. Usually, your baby’s skin heals within two weeks.

What can I expect if my baby has erythema toxicum neonatorum?

Although an ETN rash can appear uncomfortable, your baby won’t have pain, discomfort or itchiness. Keep your baby’s skin clean but avoid overwashing or scrubbing. Overwashing can lead to dry skin, which can be itchy or uncomfortable. Use fragrance-free soaps and lotions designed for people with sensitive skin.

Does erythema toxicum neonatorum return after treatment?

Although it’s uncommon, ETN can return multiple times. Some babies develop symptoms again, usually within their first six weeks of life.

When should I call the doctor?

Usually, ETN symptoms are mild and disappear within a week or two. Call your baby’s healthcare provider if your baby has:

• Blisters or oozing sores.
• Cold symptoms, such as a cough or runny nose.
• Excessive tiredness (lethargy).
• Fever.
• Rash that bleeds.
• Rash that lasts longer than two weeks.

A note from Cleveland Clinic

Erythema toxicum neonatorum is a skin condition that affects newborns. ETN is common and usually goes away within two weeks. Babies with ETN typically have a rash on their chest, belly, face or limbs. They may have small, raised bumps filled with fluid. Although the rash can look concerning, it doesn’t cause itching, pain or any other uncomfortable symptoms. ETN symptoms may reappear within a baby’s first six weeks of life.