Transitional states of newborns: erythema toxicum

Toxic erythema in a newborn is for the most part a natural protective reaction of the body from the environment, and occurs in almost 50% of infants. As other reasons, pediatric neonatologists identify the following factors: toxicosis and the presence of bad habits in the mother during pregnancy, intrauterine infections, late initiation of breastfeeding, etc. How does the pathology manifest itself and what methods of treating erythema exist? How dangerous is this for newborns and what does Dr. Komarovsky advise to do?

What is erythema?

Erythema toxicum is redness of the skin or a small rash associated with the adaptation of the child’s body to the conditions of extrauterine life (to which the baby is not yet accustomed). Symptoms of erythema are usually detected in the first hours of life or in the next 2-4 days. Sometimes skin rashes acquire a gray-yellow tint. In this case, the general condition of the child often does not change (there are no signs of inflammatory diseases or infections).

Diagnosis and treatment

In general, the infants’ well-being does not change; their body temperature does not rise. With pronounced toxic erythema, the baby becomes capricious, he has upset stool, a slight increase in various groups of lymph nodes, the spleen, and allergic eosinophil cells increase in the blood. They are also detected when taking smears from the contents of the elements of the rash.

Toxic erythema of newborns is an allergoid reaction in type. Characteristic is the absence of the immunological stage of a true allergic reaction. Treatment is most often not required, but for severe rashes, you can include additional fluids (30-60 ml of 5% glucose per day), antihistamines (Fenkarol 2.5 mg twice a day for two to three days).

How does the disease manifest?

Toxic erythema in newborns has its own distinctive features. These include:

• The appearance of small pinkish-red spots on the arms, legs (especially in the elbow and knee bends), as well as on the buttocks, face and head.
• Erythema appears within a few days after the birth of the child.
• Existing rashes may cause mild itching.
• In the center of the red spots, small bubbles with yellowish or gray liquid content may form.
• The skin at the site of the pimples may be slightly thickened.

In most cases, the rash goes away on its own within a few days, but may reappear later. And in case of relapse, toxic erythema is accompanied by other, additional symptoms, for example:

• Increased body temperature.
• Slight compaction of the lymph nodes.
• Enlarged spleen.

In the case of erythema, the rash never appears on the palms, soles and mucous membranes.

Causes

Erythema in newborns develops under the influence of the following factors:

• difficult birth,
• fetal hypoxia,
• heredity (allergic reactions transmitted at the genetic level),
• work of a pregnant woman associated with the negative effects of chemicals,
• toxicosis,
• use of medications during pregnancy,
• diseases of the endocrine system (diabetes mellitus, thyroid pathologies),
• intrauterine infection of a child,
• breastfeeding started late.

The listed factors are not considered direct provocateurs of the disease. However, they weaken the baby’s immunity, which leads to rashes on the epithelium of infants.

How dangerous is the pathology for newborns?

Due to the fact that erythema is the result of the child’s body adapting to new environmental conditions, it does not pose a threat to the life and health of the baby. However, if the rash does not go away over a long period of time, it may be a cause for concern. In this case, the baby should be shown to a pediatric specialist. Drug treatment (usually using antihistamines) may be required.

But medications must be treated with special caution, because if a newborn is “healed,” infection of the baby’s skin and pustulosis may occur, that is, purulent blisters will begin to appear, which will begin to quickly spread and spread pathogenic bacteria.

Treatment of erythema in infants

Toxic erythema, like physiological erythema, usually does not require treatment . It goes away gradually on its own. The rashes do not leave any marks on the skin. Normally, to stop the process, it is enough to maintain the child’s hygiene:

• bathe him daily in water with the addition of a decoction of string, chamomile or potassium permanganate;
• change your baby's clothes more often;
• prevent the child from overheating;
• make sure that his bed linen is clean;
• give your child regular air baths;
• make sure that the baby’s clothes are loose and do not squeeze his body;
• lubricate dry areas of skin with flaking areas with baby cream or oil;
• Do not rub the baby’s skin with a towel after bathing, but gently pat it dry with light movements.

During this period, it is recommended to give the child plenty of plain drinking boiled water.

If the erythema turns out to be protracted or complicated, then drug treatment is required. In this case, the baby is prescribed antihistamine medications, bifidobacterin or similar drugs to maintain the microflora of the stomach and intestines, B vitamins, vitamin E, ascorbic acid, rutin.

To reduce itching, you can lubricate the red rashes with antiallergic ointment prescribed by your doctor.

For severe pustular rashes, the rashes are treated with preparations containing zinc oxide, brilliant green or manganese.

For a nursing woman, it is important to switch to a dietary diet during treatment of toxic erythema in a newborn.

It is recommended to exclude foods that most often cause allergies from the mother’s diet:

• nuts;
• honey;
• oranges and tangerines;
• chocolate;
• eggs;
• red fruits and berries;
• semolina;
• buckwheat;
• chicken.

Well-established hypoallergenic nutrition of the mother will help the newborn cope with toxic erythema faster.

With properly organized care and nutrition, rashes on the baby’s skin go away without causing complications.

What to do when the first symptoms of erythema appear?

When the first symptoms of pathology appear, it is necessary to show the child to a pediatrician or pediatric dermatologist as soon as possible. And, if the doctor deems it necessary, he may prescribe additional examinations, for example:

• General blood analysis.
• Microscopic analysis of a piece of skin carefully removed from an area of ​​redness or inflammation.
• Allergy tests.
• Analysis of mother's milk for the content of suspected allergens.

Self-medication is strictly contraindicated, as it can only harm the child.

Erythema in children and adults, photos with explanations

Erythema is redness of the epidermis. This reaction of the skin can be caused by an increase or decrease in air temperature, contact of the body with hot water and other similar factors. In this case, redness of the epidermis is not a cause for concern.

If the condition occurs for no apparent reason, it is recommended to seek medical help, since it may be a symptom of a disease that threatens not only the health, but also the life of a person.

Erythema: what is it?

Skin erythema is redness of the epidermis, which occurs due to dilation of capillaries. Such vessels are located directly in the skin. For this reason, a sharp flow of blood into them affects the change in skin tone.

The prerequisites for such manifestations are most often ordinary physiological processes, but it can also be associated with pathologies.

Erythema has such types as physiological and pathological disease. Each of them has its own reasons for its occurrence.

Physiological skin erythema quickly passes and is not a consequence of the development of pathologies. Here are the reasons for this type of redness:

• reaction to changes in the emotional background - shame, indignation and others;
• vegetative-vascular disorders that occur for natural reasons, for example, during menopause or during pregnancy;
• physical impact - blow, rubbing and others;
• change in air temperature - heat or frost;
• use of medications that cause vasodilation;
• contact with the epidermis of any substances that irritate the skin - household chemicals, various ointments and other products.

This type of redness, pathological erythema, occurs due to any disease. Here are the causes of this disease:

• general pathologies caused by infections;
• chronic skin diseases - chronic erythema;
• diseases of the epidermis of non-infectious and infectious nature;
• autoimmune pathologies;
• allergies, especially to medications;
• somatic pathologies;
• physiotherapy;
• a reaction of the epidermis to ultraviolet radiation, which is called solar erythema.

The occurrence of redness often occurs due to several reasons. To cure a disease, it is necessary to get rid of the factor that caused it.

Erythema nodosum

The symptomatology of this form of pathology is the presence of red spots on the surface of the skin. They have a dense structure, and their presence on the epidermis causes discomfort in the patient. You can learn more about erythema nodosum here.

The characteristic manifestations of the disease are that the spots appear suddenly and also disappear unexpectedly. They can go away quickly or within a few days after their appearance.

In the nodular form, the inflammatory process occurs in the thickness of the epidermis and in the fatty tissue. The diameter of the rash ranges from one to ten centimeters. Locations: inner thigh and lower leg. Facial erythema in this case is extremely rare.

The manifestation of pathology is influenced by viruses that penetrate the body. In this case, the following manifestations are added to the underlying symptoms: pain in the joints, increased body temperature, inflammation of the mucous membrane of the organs of vision and general malaise.

Viral erythema

Erythema in a child develops due to the penetration of viruses into the body. Children aged 2 to 4 years are susceptible to pathology. Most often, the disease due to viruses appears in the spring or autumn. Characteristic symptoms of the pathology:

• sore throat;
• temperature increase;
• itching in the nose;
• pain in the head area;
• rhinitis;
• the appearance of rashes on the epidermis and in the oral cavity several days after viruses enter the body.

Treatment of toxic erythema

With toxic erythema, special treatment is often not required, since the rash goes away on its own. You just need to monitor your baby’s hygiene:

• Periodically give your child air baths (at least for 5-10 minutes).
• Eliminate the influence of any negative factors. That is, the baby needs to create comfortable living conditions (feed with a hypoallergenic formula or, in the case of breastfeeding, exclude all unhealthy foods from the diet of the nursing mother: chocolate, citrus fruits, nuts, eggs, honey, hot and spicy foods, use only high-quality products for bathing - without dangerous chemical additives, etc.).
• Once every 1-2 days, wet clean the room to prevent dust from accumulating.

In severe cases of the disease, the following medications are prescribed to the infant:

• Antihistamines (Suprastin, Fenistil, etc.). Although these drugs are not recommended to be given to children under 1 month.
• Lacto- or bifidobacteria to improve digestion processes and normalize intestinal microflora (Bifidumbacterin, Linex, Acylact, etc.).
• Multivitamins for newborns (especially those containing vitamin D).

Abundant rashes localized in the navel area are treated with brilliant green or a weak solution of potassium permanganate.

Under no circumstances should you self-medicate. Taking any medications must be agreed with your pediatrician. The selection of the exact dosage should also be done by a doctor. Otherwise, irreparable harm can be caused to the health and delicate skin of the baby. After all, a baby’s body is sensitive even to mother’s milk, let alone medications.

Causes of erythema

Reasons why erythema toxica occurs in newborns.

Genetic predisposition

This is considered the main reason why you may find such manifestations on your baby’s skin. It is impossible to explain such selective vulnerability - obviously, the stage of selection of such genes and their distribution occurred a very long time ago.

Mom's condition

Doctors have more than once found a relationship between prolonged and severe toxicosis of a pregnant woman and how often the child in such mothers was susceptible to skin irritation. Bad habits (and any toxins in general, if a woman has worked or is working in a “harmful” job) and taking medications in large quantities also have an effect.

Intrauterine infections

A minor but occasional provocateur. It is very difficult to keep track of intrauterine infection, because the uterus is a very protected organ that practically does not send signals to the body during pregnancy. Problems and alarming symptoms can only be seen through examination.

Late initiation of breastfeeding

If for some reason a woman cannot start feeding her child right away, this may affect the likelihood of such a problem developing in his body - perhaps this is due to a lack of nutrients.

Toxic erythema of newborns really does not pose any threat to the life of the baby, like any neonatal adaptive reaction of the body to the outside world.

Before you panic, try to understand how alien this world is for a child - a newborn simply does not have the necessary resources in the body to adequately perceive everything around him, right down to the atmosphere and processes within himself. He will receive all the necessary substances from food and auxiliary medications, if such a need arises.

Physiological erythema can bother both the child and the parents, which prompts the latter to begin treatment as soon as possible. No matter how many doctors (including the famous Dr. Komarovsky) repeat that this is an absolutely natural process for the baby, which goes away on its own, the parents’ concern is quite understandable. The manifestations on the skin look scary and look like a variety of skin pathologies.

Physiological “transitional” states of newborns

The process of birth requires the involvement of the adaptive mechanisms of the child’s body at all levels, during which “transitional” states of newborns may arise. These conditions occur during the first days from birth, generally do not require special treatment and go away on their own after a short period of time. Albuminuria

Impaired kidney function and, as a result, protein in the urine occurs in almost all newborns in the first days of life. This is due to the increased permeability of kidney cells that produce urine against the background of the peculiarities of blood movement through the vessels (after birth, the pulmonary circulation begins to function and, in connection with this, the length of the vascular bed and the resistance of the vascular walls change). However, the reaction to protein may be positive when examining urine due to the presence of salts and mucus in the urine.

Physiological jaundice

It is observed in 2/3 of newborns due to the immaturity of liver enzyme systems and increased formation of bilirubin. On the 2-3rd day of life, a icteric coloration of the skin and sometimes the mucous membranes of the eyes appears. Stool and urine retain their normal color. This condition lasts no more than 10 days. And if you feel satisfactory, no treatment is required. If the child notices noticeable weight loss, lethargy, or passivity, contact your pediatrician immediately, because this condition is not typical for physiological jaundice. You should also think about hemolytic disease if jaundice did not occur on the 2-3rd day, but on the first day of life.

Labored breathing

The first breath after birth does not fully expand the lungs. This requires a special type of breathing, which the newborn unconsciously uses. He periodically takes a deep breath, and holds back the exhalation, pushing out the air as if with difficulty - lung tissue. In a premature or weak, sick child, this process takes longer. In healthy people, on the 5th day of life, the lung tissue usually expands completely.

Changes in the skin (erythema, peeling)

Physiological erythema is a reaction of the skin to the removal of vernix lubrication, with which the child was covered in utero, expressed by its redness. It intensifies on the 3rd day of life and disappears by the end of the first week.

Physiological peeling - appears after erythema, as its outcome, most often on the chest and abdomen. Especially pronounced in post-term infants. In case of severe peeling, you can lubricate with baby cream.

Birth tumor is swelling of a part of the body, usually the head, which at the time of birth was closer to the exit of the uterus (present). Lasts 1-2 days. Sometimes small pinpoint hemorrhages appear at the site of the birth tumor and disappear on their own.

Erythema toxicum - reddish, slightly dense spots, sometimes with bubbles in the center. Occurs in 20-30% of newborns. It is located mainly on the legs and arms around the joints, on the buttocks, chest, and less often on the stomach and face. The reaction is an allergic type and usually does not require treatment. But in case of profuse rashes, when the child is restless, he should be given plenty of water, and also see a doctor who will prescribe calcium gluconate and diphenhydramine in age-appropriate dosages.

Uric acid kidney infarction

Happens to almost all newborns. It is caused by metabolic disorders in the kidneys and the deposition of crystals of uric acid salts in its zones. Externally manifested by the discharge of cloudy, brick-yellow urine. By the end of the 1st week, these phenomena disappear; from the middle of the 2nd week, the sign is considered pathological.

Sexual crises

Associated with changes in hormonal balance in most newborns. One of the manifestations is engorgement of the mammary glands (in both girls and boys) with a maximum increase on the 7-8th day, usually disappears by the end of the month. You should not try to squeeze out secretions from hardened mammary glands, because... this leads to infection and the development of mastitis. It is more useful to apply a sterile dry cloth moistened with boiled and cooled camphor oil.

In the first 2 days of life, the vaginal mucosa may become inflamed. Abundant grayish-whitish discharge appears from the genital slit, which disappears on its own on the third day. It is recommended to wash the girls with a weak solution of potassium permanganate (potassium permanganate), while making sure that no crystals get into the solution, which can cause a severe burn. You can also use decoctions of chamomile, St. John's wort, and string for the same purposes. These herbs have disinfecting properties.

More rare manifestations of a hormonal crisis are: swelling of the external genitalia - labia, penis, scrotum, which can last 1-2 weeks or more, darkening of the skin around the nipples and skin of the scrotum. Hydrocele of the testicle is an accumulation of fluid between its membranes. Sometimes it goes away only at the end of the first month of life on its own and does not require treatment.

Transient decrease in temperature, transient fever

Physiological disturbances in thermal balance are associated with imperfect thermoregulation of newborns, who cannot maintain a constant body temperature and react to any changes in it indoors or outdoors. Due to the structural features of their skin, rich in blood vessels and capillaries and poor in sweat glands, the child quickly overheats or becomes hypothermic.

When a newborn excretes more fluid than it receives during feeding, this is expressed by restlessness, dry mucous membranes, an increase in temperature to 38.5.C or higher, and thirst. He must be undressed, wiped with alcohol, cologne, and given plenty of sweet tea or boiled water. If there is no effect, do an enema with analgin.

To do this, first do the usual one to cleanse the intestines to ensure better absorption of the medicine, and then directly an enema with analgin. Crush one tablet (0.5 g) into powder, and dissolve 1/10 of it in water with a volume of a small rubber can designed specifically for newborns. The expected relief will come in 20-30 minutes.

If the baby’s temperature, on the contrary, is low, which most often happens in the first hours of his life, he should be quickly wrapped in sterile diapers (ironed if the birth took place at home) and placed on a changing table under a lamp. A constant body temperature is established, as a rule, by the middle of the first day.

Physiological dyspepsia, dysbiosis

The complete absence of bacteria is characteristic only of the fetus, which is sterile during normal pregnancy, and of the newborn in the first hours of life. But after 10-20 hours, his skin, mucous membranes of the respiratory tract and intestines are populated by microorganisms, some of which are necessary for digestion, and how it proceeds can be seen in the feces.

Stool disorder - physiological dyspepsia, occurs in all newborns. Initially, for the first three days, original meconium is released - thick, dark green. Then patches of yellow and whitish color appear in it, bowel movements become more frequent - from dense lumps to a liquid consistency. This physiological dyspepsia does not last long. After 2-4 days, the feces become mushy, uniformly yellow in color - a permanent stool is established, which indicates the growth of bacteria in the intestines that normalize digestion.

Physiological weight loss

This condition is typical for children on the 3-5th day of life. The child loses 5-8% of his body weight at birth, mainly due to the evaporation of fluid through breathing due to insufficient intake from the outside. Most regain body weight by the end of the first - beginning of the second week. Early breastfeeding, 2 hours after birth, contributes to less loss.

It should also be remembered that in addition to milk, a child needs additional drink - water, and that someone who experiences overheating or hypothermia spends energy for other purposes - at least to partially restore the thermal balance.

Body weight also tends to decrease when the mother has insufficient milk. The pediatrician observing the child must choose the best option for a special milk formula and instruct the mother in detail how much it should be given during supplementary feeding. It is unwise to choose a mixture on your own without consulting a doctor.