Pediatric emergency medicine trisk 1322 1322
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CHAPTER 69 ■ RASH: NEONATAL
ADITI S. MURTHY
INTRODUCTION
Rashes are common in the neonatal period and can cause significant parental
distress. The ability to distinguish worrisome rashes from those that are benign is
of critical importance. To provide a schema for understanding rashes in the
neonate, it can be helpful to divide the rashes into categories: pustules, vesicles,
patches/plaques, hamartomas, and dyspigmentation. Within these categories,
there are signs and symptoms that push the clinician to be more or less concerned.
PUSTULAR ERUPTIONS
Pustular rashes in neonates are common and can be caused by inflammation (such
as in erythema toxicum and transient neonatal melanosis) or infections (yeast,
bacteria like Staphylococcus aureus, and, rarely, herpes simplex virus [please see
vesicular neonatal rashes below for full discussion of herpes simplex]). The goal
of recognition is to spare healthy infants with benign pustular eruptions extensive
workups and not to miss those with more serious pustular eruptions.
Neonatal Acne
Neonatal acne is a fairly common papular and pustular eruption of the forehead
and face ( Fig. 69.1 ). The etiology is possibly due to overgrowth of commensal
yeasts. Treatment is not always necessary as this can be self-limited. Neonatal
acne distinguished from true “acne” in the sense that unlike infantile or
adolescent acne there are no comedones or scarring lesions.
Erythema Toxicum Neonatorum
Erythema toxicum neonatorum (ETN) is usually evident within the first 48 hours
of life. The rash typically has mixed features with erythema, wheals, papules, and
pustules ( Fig. 69.2 ). This transient rash resolves spontaneously without sequelae
over the course of 1 to 2 weeks. Histologically, ETN shows an abundance of
eosinophils. Etiology is unclear. One prospective study of 1,000 neonates
suggested that risk factors include higher birth weight, greater gestational age,
vaginal delivery, maternal age <30 years, and fewer than two previous
pregnancies. Culture and Gram stain looking for eosinophils can help distinguish
from bacterial infection.
