Erythematous pustules and papules with some coalescence developed on the anterior trunk and to a lesser degree on the face and extremities of a newborn boy the day after birth. The baby was born at full term after an uncomplicated pregnancy and delivery.
These lesions are characteristic of erythema toxicum. This benign, asymptomatic macular rash of unknown etiology may present with or without pustules and papules within the first few days of life in full-term infants, or within the first 2 weeks of life in premature infants. The incidence varies and may increase with gestational age. Lesions may occur anywhere on the body, except the palms and soles. The rash may wax and wane but is self-limited; it typically resolves within 2 weeks—as it did in this infant.
Diagnosis is generally based on the appearance of the rash. The differential diagnosis includes congenital infections, pyoderma, candidiasis, herpes simplex, transient neonatal pustular melanosis, milia, and miliaria. Of these, it is most important to rule out herpes simplex. Any neonatal lesion of a vesicular nature warrants closer observation.
Parental reassurance is the only treatment necessary.