You are rounding in the newborn nursery. A healthy 2-day-old term infant has a new rash characterized by yellow pustules on an erythematous base involving the trunk and extremities but sparing the palms and soles.
What is the diagnosis?
A) Transient neonatal pustular melanosis.
B) Herpes simplex.
D) Erythema toxicum neonatorum.
E) Epidermolysis bullosa.
Answer And Discussion
The correct answer is “D.” Erythema toxicum neonatorum.
Erythema toxicum neonatorum is a common, benign, self-limited rash seen in term infants. Lesions usually appear after 24 hours of age. Lesions may begin as erythematous macules that progress to
yellow pustules on an erythematous base, may be sparse or numerous and involve the trunk and
extremities, sparing the palms and soles.
The etiology is unknown and the diagnosis is clinical.
Transient neonatal pustular melanosis usually affects term African American infants presenting at birth with pustules on a hyperpigmented macule that may involve the palms and soles.
Neonatal herpes presents with blisters or erosions and an ill-appearing child. Diagnosis is made via a Tzanck preparation demonstrating multinucleated giant cells, viral culture, or direct fluorescent
antibody for HSV 1 or 2. Commonly seen in warm climates,
Miliaria or “prickly heat” is due to blocked sweat ducts presenting as noninflamed pinpoint clear diffuse vesicles.
Epidermolysis bullosa is a chronic blistering disease presenting as blisters at sites of mild trauma.