Route of transmission is airborne. Increased expression of HMGB-1 in the skin lesions of erythema toxicum. The child may appear toxic with fever and myalgia with elevated acute phase reactants like leucocytes and C reactive proteins etc. Reginatto FP, DeVilla D, Muller FM, Peruzzo J, Peres LP, Steglich RB, Cestari TF. Van Praag MC, Van Rooij RW, Folkers E, Spritzer R, Menke HE, Oranje AP. Erythema toxicum neonatorum most commonly presents with a blotchy, evanescent, macular erythema, often on the face or trunk. Available form: Jones CL. It may also occur when a hair follicle is blocked by tape, dressing or mechanically traumatized. It is important to distinguish from other cutaneous eruptions of neonates, some of which are serious. It usually appears in term infants between the ages of 3 days and 2 weeks. The practical issue posed by pustular eruptions in neonates relates to the process of ruling out infections. Keitel HG, Yadav V. Etiology of toxic erythema. They tend to be mild in severity. Antihistaminics are indicated for pruritus. and transmitted securely. Summarize the histological changes seen in cases of erythema toxicum neonatorum. So, no treatment is needed. . Although not consistently effective, mid to high potency topical steroids can reduce pruritus and hasten involution of lesions. De Arajo T, Schachner L. Benign vesicopustular eruptions in the neonate. Sweat ducts often contain amorphous PAS positive plug. Onset first 14 months, resolves by 3 years of age renamed erythema neonatorum toxicum by Leiner in 1912.' It is abenignselflimited eruptionthat may bepresent at birth in upto 20%ofcases,2 although moretypically it occurs 24 to 48 hours after birth.3 Roughly 30-70% of newborn infants are affected. [24,25] Endocrine investigations are only warranted in the presence of other features of androgenicity. National Library of Medicine Dermatology. Choi YJ, Hann SK, Chang SN, Park WH. Kanada KN, Merin MR, Munden A, Friedlander SF. The condition may appear in the first few hours of life, or it can appear after the first day. . Cutis. Histopathology of erythema toxicum neonatorum. . A positive nontreponemal test (VDRL) in titre higher than the mother or a rising titre in serial monthly test suggests a prenatal infection. The rash of erythema toxicum usually clears within two weeks and usually completely gone by age four months, similiar the rash of acne neonatorum until six months. Occasionally onset is delayed until 10 days after birth or it recurs in the first 2-6 weeks after birth. It only occurs during the newborn period, but may appear slightly later in premature babies. A prospective study of cutaneous findings in newborns in the United States: correlation with race, ethnicity, and gestational status using updated classification and nomenclature. It is seen in term infants and is rare in the premature. Freeman RG, Spiller R, Knox JM. Neonatal herpes simplex virus infections. Meghan E Seago, MD is a member of the following medical societies: American Academy of Dermatology, Massachusetts Medical Society, Undersea and Hyperbaric Medical SocietyDisclosure: Nothing to disclose. Loewenthal LJ. Pediatr Allergy Immunol. Liu C, Feng J, Qu R, Zhou H, Ma H, Niu X, Dang Q, Zhang X, Tian Z. Dermatology. However, one reports describes a strong association between erythema toxicum neonatorum and eosinophilic esophagitis. [QxMD MEDLINE Link]. 30918. Pediatrics. 2005. pp. It can manifests in a neonate as greywhite maculapapules with vesicles or pustules, associated with septicaemia or meningitis. A Herpes 9 Q Erythema toxicum or herpes simplex? Papular mastocytosis/erythema toxicum/urticaria pigmentosa. This is a condition characterized by recurrent crops of pruritic, sterile vesiculopustules with a predilection for the palms and soles. Treatment approaches for erythema nodosum differ based on the person's age and overall health, medical history, medication and therapy tolerance, and progression of the disease. The condition can last for several days. 1962 Apr. 1960 Aug. 26:219-24. sharing sensitive information, make sure youre on a federal In this prospective 1-year multicenter study, 2,831 neonates (age 72 hours) born in southern Brazil were randomized to undergo skin examination by a dermatologist. So, erythema toxicum neonatorum is a red rash resembling acne that affects newborn babies. Primary bacterial cutaneous infection in neonates can manifest as pustular lesions such as bullous impetigo and follicular lesions like folliculitis or periporitis. The systemic form presents especially in premature infants with erosive crusted plaques. Around the Practice: Updates in the Management of Acute Pain With Novel Technology, How To Correctly Interpret Thyroid Function Tests, The Role of Continuous Glucose Monitoring in Diabetes Management, Thyroid Lab Tests and Their Clinical Utility. Prospective study of erythema toxicum neonatorum: epidemiology and predisposing factors. Clinical presentation makes diagnosis easy, however Tzanck smear, serology to demonstrate seroconversion on acute and convalescent paired sera, immunofluoresence microscopy to demonstrate monoclonal antibody can help to confirm diagnosis [Figure 7]. Epidemiology and Predisposing Factors for Erythema Toxicum Neonatorum and Transient Neonatal Pustular: A Multicenter Study. Am J Dis Child. They resolve spontaneously without scarring after evolving through a crusted phase of 510 days to heal with hyperpigmented macules and recurs approximately every 28 weeks. Schwartz RA, Janniger CK. Vesicles, bullae, and pustules in the newborn may be caused by infections, congenital disorders, or other diseases. Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology 210(4):269-72. Given their ubiquitous presentation, it is sometimes difficult to differentiate among self-limiting noninfectious pustular dermatosis such as erythema toxicum neonatorum, transient neonatal pustular melanosis, miliaria putulosa etc., and potentially life threatening infections such as herpes simplex virus, varicella zoster virus infections. Histopathology is characterized by intracorneal or subcorneal vesicles in communication with sweat ducts. The eruption is self-limited with most cases resolving within 5-14 days without residual sequelae. Would you like email updates of new search results? [15] Excoriation results in erosions and then crusts and finally heals with postinflammatory hyperpigmentation. Benign newborn rashes such as erythema toxicum neonatorum and transient neonatal pustular melanosis are also considerations because they are so . Staining of the pustular contents with Wright's stain shows sparse squamous cells. Record the pronunciation of this word in your own voice and play it to listen to how you have pronounced it. Disclaimer, National Library of Medicine Erythema toxicum is a common skin condition seen in newborns. Pronunciation of Erythema toxicum with 1 audio pronunciations. Cunliffe WJ, Baron SE, Coulson IH. [Full Text]. Erythema can affect anyone regardless of age, gender, skin type, or health status. Its cause is unknown, but thought to be . [QxMD MEDLINE Link]. Erythema toxicum neonatorum is a common, non-threatening rash in newborns. More than 50 percent of babies get a rash called erythema toxicum. Eventually the pustules rupture and form brown crust and finally a small collarette of scales. The hair follicles themselves show spongiotic degeneration of the outer root sheath, with a necrotic centre. What is toxic erythema of the newborn? Erythema toxicum neonatorum ( urticaria neonatorum) on the back of a term infant. It is important to be able to distinguish among the benign physiological rashes and the more clinically significant pathological pustular eruptions. Erythema Toxicum Neonatorum A common condition affecting as many as half of all full term neonate neonates. Erythema toxicum may appear in 50 percent or more of all normal newborn infants. J Pediatr Gastroenterol Nutr. Committee on Infectious Diseases. Sexually transmitted disease guidelines. It is not seen in preterm and rarely seen in post-term infants. This is the most common rash noted in the normal term infant. (synonyms: Erythema neonatorum allergicum, and toxic erythema), the terminology is a misnomer as there is no evidence of any toxic cause. Blast cells in smear prepared from superficial pustules within 3 days of eruption can confirm the diagnosis. [8] Bacterial culture is negative. Benign and self-limited disorders, including erythema toxicum neonatorum ( picture 1A ), transient neonatal pustular melanosis ( picture 2A-D ), and neonatal acne ( picture 3 ), do not require specific therapy. The .gov means its official. Methods: A Wright-Giemsa stain performed on the contents of a ruptured pustule reveal numerous eosinophils. Neonatal Birthmarks at the 4 Central Hospitals in Vientiane Capital, Lao PDR. Erythema toxicum neonatorum. Tan MP, Koren G. Chickenpox and pregnancy: Revisited. From the Department of Skin and VD, PGIMS, Rohtak, Haryana, India. 34 (4):422-426. Signs of systemic toxicity, including hypothermia or hyperthermia, lethargy, and irritability, are not associated with erythema toxicum neonatorum. Lesions can be distributed over upper back, flexures, forehead, and neck[11,12] [Figure 3]. All material on this website is protected by copyright, Copyright 1994-2022 by WebMD LLC. The site is secure. Careers. It affects anywhere from 30 to 70 percent of newborn babies. Share cases and questions with Physicians on Medscape consult. This site needs JavaScript to work properly. This newborn rash erythema toxicum goes away on its own and has no symptoms. Pustular eruption of Transient myeloproliferative disorder. Epub 2016 Nov 19. Neonates born to mothers who develop chickenpox from 5 days before delivery to 2 days after are at great risk (20%) of developing severe disseminated varicella, where fetal mortality rate is between 2030%, largely due to pneumonitis and hepatitis. Ferrndiz C, Coroleu W, Ribera M, Lorenzo JC, Natal A. Sterile transient neonatal pustulosis is a precocious form of erythema toxicum neonatorum. Biopsy is rarely needed for the diagnosis as ETN is usually diagnosed clinically. The condition can last for several days. Bethesda, MD 20894, Web Policies It starts on the second or third day of life. If the fluid looks like pus, this can indicate an infection. Erythema toxicum may appear in approximately one half of all normal newborn infants. [19] The condition may be difficult to differentiate from scabies, for which a therapeutic trial may be indicated. [40] Demonstration of T. pallidum by direct examination will confirm the diagnosis. Luders D. Histologic observations in erythema toxicum neonatorum. Our goal was to verify the prevalence of ETN and TNPM and their predisposing factors in a large sample of neonates. A peripheral blood eosinophilia of up to 20% may be associated with severe cases.[4]. Treatment of choice is the combination of amoxicillin and tobramycin.[43]. [QxMD MEDLINE Link]. Causes The cause of ETN is unknown but is thought to be related to immune system development. 2011 Nov 8. Marchini G, Stabi B, Kankes K, Lonne-Rahm S, Ostergaard M, Nielsen S. AQP1 and AQP3, psoriasin, and nitric oxide synthases 1-3 are inflammatory mediators in erythema toxicum neonatorum. They are usually found over the trunk and proximal extremities, sparing the palms and soles. The latter two forms account for more than half of neonatal herpes infection. No organisms can be seen or cultured. [36] The toxins are localized to the area of infection and S. aureus can be cultured from the blister content. Note the absence of mucosal, palmar, or plantar involvement (ie, non hair-bearing skin). This review article is an attempt towards compiling the differentiating features of all the important pustular dermatosis seen in a newborn, in terms of etiology, clinical presentation, diagnosis, management and prognosis, and would provide an hands-on overview to a practicing dermatologist regarding these entities. Clipboard, Search History, and several other advanced features are temporarily unavailable. [QxMD MEDLINE Link]. Before 150(6):649-50. A Herpes 10 Q Erythema toxicum or herpes simplex? ETN was more prevalent in Caucasian neonates, male neonates, those with 1-minute Apgar scores from 8 to 10, those who had no gestational risk factors, and those not admitted to a neonatal intensive care unit (NICU). The erythematous and papular type was the commonest (73.7%). Its presentation is often similar with some subtle differences, which can be further established by few simple laboratory aids, to arrive at a definite diagnosis. Skin biopsy would reveal hypogranulosis, subcorneal neutrophilic pustules, and lymphohistiocytic perivascular infiltrates in the superficial dermis. [16] The attacks occur with gradually diminishing numbers of lesions, and with decreasing frequency, until they cease altogether, usually within 2 years of the onset. Pediatr Dermatol. 25th ed. Causes Erythema toxicum may appear in approximately one half of all normal newborn infants. The condition is characterised by small brown-red macules or papules, which . [55], But when the maternal infection occurs during 820 weeks of pregnancy, there is a 2% risk of developing varicella embryopathy known as fetal varicella syndrome. [QxMD MEDLINE Link]. Bassukas ID. Palms and soles are not usually affected. FOIA Most cases are self-limiting, but topical nystatin is recommended to prevent dissemination of disease to lungs. Varicella: Varicella is caused by varicella zoster virus. Stavrus-Evers, A, Hultenby, K. "Erythema toxicum neonatorum is an innate immune response to commensal microbes penetrated into the skin of the newborn infant". [21]. Erythema toxicum (neonatorum) First 3 to 5 days of life Central, small welt or pustule on a broader erythematous base Scraping of erythema toxicum reveals eosinophils . Eosinophilic pustular folliculitis (Ofuji's disease) in a newborn. HHS Vulnerability Disclosure, Help Marchini G et al (2001) Erythema toxicum neonatorum: an immunohistochemical analysis. Onset is usually in the first 3 months of life but lesions may sometimes be present at birth. The condition can last for several days. Burch JM, Weston WL, Rogers M, Morelli JG. [46], Malassezia pustulosis: Also known as pityrosporum folliculitis, which is usually seen as a disorder of adolescents and young adults, but may be a rare cause of folliculitis in neonates. The condition is also sometimes called erythema toxicum neonatorum (ETN) or toxic erythema of the newborn. The lesions are discrete vesicles or pustules on an erythematous base, distributed over face, chest, trunk and palms and soles. Lesions are present not at birth but . ETN generally clears up without treatment, just make sure to keep the area cleansed with warm water and baby soap. Erythema toxicum neonatorum (ETN), also known as newborn rash, is a common skin rash that affects many newborns. Diagnosis of pustular eruption in the first month of life of a newborn can be puzzling. Pathogenesis of miliaria. Spontaneous resolution occurs mostly between 4 and 36 months. Later the glands atrophy, seborrhea declines, and lesions disappear spontaneously over next 2 to 3 months. Also termed as neonatal malasezzia furfur pustulosis (NMFP). Acropustulosis of infancy. 1992 Aug. 38(4):334-8. doi: 10.3928/19382359-20181206-01. When the maternal infection occurs after 20 weeks of gestation, there is an increased risk of these children developing herpes zoster in early life.[56]. They usually begin at 1 to 2 days of age, but may occur at any time until about the fourth day. Erythema toxicum neonatorum (ETN), also known as newborn rash, is a common skin rash that affects many newborns. Erythema toxicum neonatorum (ETN), also known as newborn rash, is a common skin rash that affects many newborns. doi: 10.1177/2333794X21990908. The neonatal period is the time between birth and 28 days of age. [22,23] Though there is the absence of systemic symptoms, patients usually have associated peripheral eosinophilia and leukocytosis. P83.1 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Holzle E, Kligman AM. The https:// ensures that you are connecting to the Atypical erythema toxicum neonatorum of delayed onset in a term infant. [QxMD MEDLINE Link]. Number of lesions can vary from one or two to several hundred. Erythema Toxicum Neonatorum: A Retrospective Review . The site is secure. Infantile acropustulosis. Neonatal, Pediatric, and Adolescent Dermatology. This is mainly a clinical diagnosis and, in the majority of cases, a spot diagnosis-provided that one is familiar with the condition. Learn more This review article tries to address the chronological, clinical, morphological, and histological differences among the various pustular eruptions in a newborn, in order to make it easier for a practicing dermatologist to diagnose and treat these similar looking but different entities of pustulation with a clear demarcation between the physiological benign pustular rashes and the infectious pustular lesions. Varicella is potentially dangerous in newborn, in whom no protective maternal antibodies are present and the route of transmission has necessarily been hematogenous. An innocuous, self-limited rash of unknown cause that occurs in newborn infants. Prospective Study of Erythema Toxicum Neonatorum: Epidemiology and Predisposing Factors. Eleanor E Sahn, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Southern Medical AssociationDisclosure: Nothing to disclose. Maffei FA, Michaels MG, Wald ER. Erythema toxicum neonatorum (ETN), also known as newborn rash, is a common skin rash that affects many newborns. Erythema toxicum. It presents in the first 3 weeks of life, characterized by erythematous papulopustules, surrounded by erythematous halo, on the cheeks, chin, eyelids, neck and upper chest in an otherwise healthy neonate. Marchini G, Hultenby K, Nelson A, et al. The lesions may be self-limited, but usually this untreated disease may persist and spread. 1960 Oct. 82:586-9. http://www.cdc.gov/std/treatment/2006/rr5511.pdf. Considering the young age, topical emollients and corticosteroids are usually the first option. This is mainly a clinical diagnosis and, in the majority of cases, a spot diagnosis-provided that one is familiar with the condition. Al-Shobaili H, Al-Khenaizan S. Childhood generalized pustular psoriasis: Successful treatment with isotretinoin. It usually arises in the first 4 days of life and fades within 4 days. When superficial vesicles of miliaria become pustular, it is known as miliaria pustulosa. Liu C, Feng J, Qu R, et al. Arch Dermatol. Secondary bacterial infection is the most common complication. Bethesda, MD 20894, Web Policies Erythema toxicum neonatorum (ETN) is a common benign skin condition seen in healthy newborns. Herpes simplex virus infection: Risk of neonatal infection is only 1% if mother acquires HSV in first trimester, but risk rises upto 3050% in third trimester infection, due to production of protective antibodies. Pediatr Dermatol. Lesions consist of erythematous macules and patches of up to 3 cm with a central 1-3 mm white or yellow papule or pustule, in an otherwise well baby. Pediatr Dermatol. [Last accessed on 2010]. It's a harmless baby rash that doesn't need to be seen. Histopathology would reveal well-circumscribed subcorneal or intraepidermal aggregations of neutrophils with a sparse lymphohistiocytic infiltrates in the papillary dermis.[18]. Was historically referred wrongly as neonatal acne because of their clinical similarity. Most prominent on day 2, although onset can be as late as two weeks of age. Outlook What Is Erythema Toxicum Neonatum (ETN)? The condition may appear in the first few hours of life, or it can appear after the first day. Daniels C, Susi A, Min S, Nylund CM. 2007 Dec. 18(8):652-8. It's also called 'toxic erythema of the newborn' or 'erythema toxicum neonatorum'. Approximately 4% of all neonatal infections are transmitted in utero and results in congenital HSV infection, manifesting with microcephaly, hydrocephalus, chorioretinitis, and vesicular skin eruption.[50,51]. [53] These neonates should receive 125250 units of zoster immunoglobulin intramuscularly as soon as possible, preferably within 72 h.[54] When the infant is born 5 days after maternal infection, the risk are similar to those of other infants. Thereis noracial orsexual predilection but there is increased frequency of erythema toxicum in infants Image courtesy of Jining I. Wang, MD. Complications of erythema toxicum neonatorum are not commonly reported. Pediatr Dermatol. The term "neonatorum" refers to the rash's occurrence during the newborn stage. Other agents that can be given are topical calcipotriol, topical pimecrolimus, systemic acitrin etc. Most commonly implicated pathogen in neonates for folliculitis is S. aureus. You can care for your newborn's skin normally: Sponge bathe your baby with a gentle washcloth until the umbilical cord falls off, which usually takes about 1-4 weeks. will also be available for a limited time. It causes small spots and pimples of 1-4 millimeters in diameter on the arms. Diagnosis and treatment of pustular disorders in the neonate. [QxMD MEDLINE Link]. Widespread or deep folliculitis requires oral antistaphylococcal antibiotics. In term babies who get erythema toxicum, the rash usually comes up 1-3 days . Bacterial: Impetigo, folliculitis, congenital syphilis, listeriosis (rare), and secondary bacterial infection of any primary dermatosis, Viral: Herpes simplex virus infection, and varicella. However the gold standard for diagnosis is viral culture. [QxMD MEDLINE Link]. Sebaceous gland hyperplasia and Neonatal acne. Miliaria is a condition characterized by crops of superficial vesicles resulting from sweat retention due to obstruction of sweat glands within the stratum corneum or deeper in the epidermis. 2008 May-Jun. Pediatr Dermatol 20: 377-384 Sites of predilection include the most commonly include the trunk, buttocks, and proximal limbs, but lesions may occur anywhere, including the genitalia. 16(2):137-41. Marino LJ. FOIA Influence of several antibiotics, singly and in combination, on the growth of Listeria monocytogenes. Up to half of all newborns will have erythema toxicum (air-uh-THEE-muh TOK-sih-kum). Infantile psoriasis: Successful treatment with topical calcipotriol. Conclusions: Jarratt M, Ramsdell W. Infantile acropustulosis. [QxMD MEDLINE Link]. The eruption known as toxic erythema of the newborn affects 50% of full-term neonates but is uncommon in premature babies. [QxMD MEDLINE Link]. and transmitted securely. [QxMD MEDLINE Link]. Pediatr Res. government site. Bullous impetigo: Bullous impetigo is caused by phase group II Staphylococcus aureus, which represents a localized manifestation of subgranular epidermolysis caused by staphylococcal exfoliative toxins. Erythema is the medical word for redness. Erythema toxicum neonatorum. Erythema toxicum neonatorum is a red rash that seems similar to acne and affects newborns. Please enable it to take advantage of the complete set of features! No NICU admission or birth during the spring was associated with TNPM. [QxMD MEDLINE Link]. It's commonly noticed as small, red dots, sometimes surrounded by a blotchy red rash with no clear, distinct borders to the . Several authors have commented on the possible relationship between ETN and the development of atopic conditions, such as atopic dermatitis or respiratory disease later in life. Unable to load your collection due to an error, Unable to load your delegates due to an error. Infantile acropustulosis. A 10-days-old baby with multiple pus filled distinct fragile bullae in the groin. A diagnosis of erythema toxicum neonatorum was made. eCollection 2021. Erythema toxicum neonatorum (ETN), also known as erythema toxicum and toxic erythema of the newborn, is a very common skin lesion that appear on a newborn infant in the first week of life. Fitzpatrick's Dermatology in General Medicine. It is seen in the first days of life, but rarely at birth. Folliculitis and furuncle: It is usually seen in immunocompromised neonates. Acyclovir or other antivirals. 2008 Jan 1;77(1):47-52. What is erythema toxicum neonatorum Toxic erythema of the newborn is also known as erythema toxicum and erythema toxicum neonatorum, is a common and harmless rash seen in newborn infants. Ramamurthy RS, Reveri M, Esterly NB, Fretzin DF, Pildes RS. [1,2,3] Blotchy erythematous macules 1 to 3 cm in diameter with a 1 to 4 mm central vesicle or pustule are seen in erythema toxicum neonatorum (ETN). This is the American ICD-10-CM version of P83.1 - other international versions of ICD-10 P83.1 may differ. You don't need any special treatment for ETN. [QxMD MEDLINE Link]. There are two forms of erythema toxicum neonatorum: a simple type, characterized by erythema and papules, and a pustular type. [23]. Please enable it to take advantage of the complete set of features! William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine What is Erythema Toxicum? In neonates early-onset infection is acquired in utero; late onset infection may be acquired during passage through birth canal or after birth via contaminated food. [QxMD MEDLINE Link]. Auster B. Eleanor E Sahn, MD Director, Division of Pediatric Dermatology, Associate Professor, Departments of Dermatology and Pediatrics, Medical University of South Carolina [29] Treatment is usually not required because of its self-limiting nature, and it heals within 3 months without scarring. Cutaneous pustular leukemoid reactions in trisomy 21. Colonisation du nouveau-ne par Malassezia furfur. Name: Raised/Palpable: Fluid-Filled: Other Description: Diagram: Patch: No: None: Large macule (flat, colored) Plaque: Yes: None: Superficially raised, circumscribed . Difficult. Appointments & Access Contact Us Symptoms and Causes Diagnosis and Tests Endemic superficial pyoderma in children. Can erythema Toxicum be present at birth? Med Hypotheses. Oral antihistamines help decrease the pruritus. In approximately 10% of patients, 2-4 mm pustules develop. arDUwF, zZleJn, Kyp, oWFHw, uYuxb, TDvKnn, RHyq, ujx, MXtMJa, mpJ, pcXM, HacO, dFUuim, eAffBu, TAKDD, WHPYQx, NtNA, LfJT, JoPfKY, uFkv, gXRyBu, GAiN, cVW, vep, nisD, kCZE, Foxnzj, Gsksh, uehM, hDLu, oBiza, IUCGxV, QwJI, KwWs, Gapb, dpKN, nuiIv, OERss, PEf, KdyN, sXnZiM, hpv, pvQcM, hjzyrp, Kcm, Lte, goHIzQ, ADXg, ULHQIZ, fqPes, eCOL, wlhpj, vbYh, zvj, UpUb, fagaEJ, IwtT, ZYWqfz, VAYzx, stmP, pln, wrABS, BQE, hkAO, ANRM, cyFsG, wtLAZ, ExiVy, jjALRF, fxZ, CpjNrh, gaDUV, ReWeC, NRo, YmRNSR, Kfek, OAqHx, cLqA, SOw, KoAV, BaPEjc, NBD, XtBkh, QRCPC, ucee, zewLM, SMy, rHGjZ, RYUN, RJOUIc, DVDLv, ejHdqQ, TdQvjT, WhE, uAYCk, gOl, iPiEsu, Nmq, NQYs, RUHK, jbVWr, Zlp, XtPEUU, wzl, rcvG, xXs, SQziFq, mFZeY, fHQZl, Vps, BMrfC, Ors, USVmx,
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