Integumentary system ORGAN SYSTEMS

Erythema Toxicum Neonatorum (ETN)

Benign, self-limited, transient, toxic erythema of the newborn usually occurring in the first 48 hours of life.


Benign, self-limited, transient, toxic erythema of the newborn usually occurring in the first 48 hours of life.

  • Seen in 50–70% of all healthy newborn infants, particularly those born at term
  • Does not occur outside the neonatal period


The rash of erythema toxicum neonatorum has been described by physicians for centuries. Ancient Mesopotamians believed that it represented a cleansing mechanism against the mother’s blood.

In the modern era, condition was described as early as the 15th century by a pediatrician named B. Metlinger. It has been associated with a reaction to meconium to the skin of the baby, and the name of the condition has changed several times over the years, from erythema populated to erythema dyspepsia and erythema neonatorum allergicum. In 1912, Dr. Karl Leiner, an Austrian pediatrician, named the condition erythema toxicum neonatorum and currently this is the denomination used for these skin findings.


  • Characterized by blotchy red spots on the skin with overlying white or yellow papules or pustules.
    • Lesions may be few or numerous.
    • Eruption typically resolves within first two weeks of life, and frequently individual lesions will appear and disappear within minutes or hours.
Typical rash of erythema toxicum
One-day-old infant with a typical rash of erythema toxicum with papulopustules on poorly defined erythematous macules. | Marchini, G., Nelson, A., Edner, J. et al. Erythema Toxicum Neonatorum Is an Innate Immune Response to Commensal Microbes Penetrated into the Skin of the Newborn Infant. Pediatr Res 58, 613–616 (2005).

Differential diagnosis:

  • Herpes simplex virus
  • Impetigo
  • Neonatal sepsis
  • Listeria
  • Varicella (chicken pox)
  • Staphylococcal scalded skin syndrome
    • Classically occurs within the first 24 hours after birth (not 2-5 days after) and carries with it a much more severe clinical picture.


The disease is self-limiting and resolves on its own.

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