Collodion baby

A two-day-old, full-term, non-consanguineous, male baby weighing 2.3 kg had sheets of peeling parchment-like membrane, fissuring in the body folds, generalized diffuse erythema [Figure 1], mild ectropion [Figure 2], and deformed pinnae [Figure 3]. The other male sibling had reportedly died earlier of a similar condition at the age of 10 days. He was uncomfortable, afebrile, accepting feeds orally, and had neonatal jaundice. The molting of skin was complete by the tenth day of life.

Figure 1.

Collodion baby, two days after birth, with sheets of peeling, parchment-like membrane, fissuring in the body folds, and generalized diffuse erythema

Figure 2.

Mild ectropion of both eyes.

Figure 3.

Deformed pinna

Collodion baby is a rare genodermatosis of unspecified inheritance, affecting both sexes equally. The neonate is born often prematurely, encased completely in a yellowish, taut, glistening, parchment-like membrane that restricts its movements minimally. The skin markings are obliterated and mild ectropion, eclabion, and flattened pinnae are usual. Nasal obstruction, when present, needs probing, as otherwise it will restrict breathing. The collodion membrane starts drying early and cracks / sheds completely within two weeks of life, exposing the infant to the risk of hypothermia, skin and lung infections, septicemia, and electrolyte imbalance, with a propensity for renal and neurological damage. About 90% of these cases evolve into non-bullous ichthyosiform erythroderma or less often lamellar ichthyosis. The management is primarily supportive and nursing in humidified incubators at birth will prevent complications. Bland emollients are preferred to topical steroids lest their increased absorption, due to the compromised skin barrier, lead to systemic toxicity. Harlequin ichthyosis, a lethal autosomal recessive disorder, is differentiated by its grotesque appearance, thick, adherent, and armor-plate-like scales, restricting movements severely, deep cracks and fissures, mitten-like hands, severe ectropion, fish-mouth-like eclabion, and rudimentary / distorted ears. Chrysalis babies are cases with intermediate features. In stiff baby syndrome (restrictive dermopathy), the skin at birth is taut, thick, unyielding, and does not desiccate in the neonatal period, which may lead to respiratory failure and early death.