Only
Only ~270 cases of collodion babies have been reported in the literature since 1892, when the term was first introduced by Hallopeau and Watelet [
We report a unique case of a Caucasian male that was born as a Collodion baby at the University of Kentucky Children’s Hospital in Lexington, Kentucky. Although the impairment of the skin barrier function put the patient at risk for a number of complications, he improved significantly after being treated with emollients and antibiotics. In contrast to the findings of van Gysel et al., we found that skin emollients were beneficial and did not increase the risk of infection.
We present the case of a Caucasian male infant who was born at 37 weeks’ gestation to a 19-year-old, gravida 3, para 1001, mother. The mother received regular prenatal care, including prenatal vitamins and iron during pregnancy and also received Stadol for pain relief during labor. Toward the end of her pregnancy, the mother developed idiopathic thrombocytopenic purpura (ITP). Mother was hepatitis B negative, HIV negative,
The patient’s birth weight was 2499 grams. Upon initial physical examination, the patient presented with a thin collodion membrane that was found over the majority of his skin surface. He was active and alert and appropriately responsive during the examination. The physical examination was unremarkable except for apparent inability to close the eyes completely and limited range of motion in all joints due to the taut collodion membrane. The patient’s hearing was assessed to be normal, and his nails were normal in appearance and did not show any dystrophic changes, excluding the possibility of the keratitis, ichthyosis, and deafness (KID) syndrome. The patient could not purse his lips and was also noticed to have blanching of the eyelids. On day 7, he was noted to have slightly increased work of breathing due to upper airway obstruction from dried skin plugs.
The patient was admitted to the neonatal intensive care unit (NICU) and placed in a humidified incubator with a cardiorespiratory monitor. At 6 hours of age, electrolytes were all within normal limits. Nasogastric feedings were initiated because of the patient’s inability to suck. During his stay, the patient began daily bathing with either basis sensitive skin soap. Eucerin emollient cream and Aquaphor were also applied routinely every 3 to 4 hours. Once he began to crack and peel, Bacitracin zinc ointment was applied twice daily to the fissures in his skin to prevent infections. Lacri-Lube for the eyes was used every 4 hours to keep the corneas moist, and ammonium lactate was added as a keratolytic to augment the peeling process once the peeling started. He was placed on nasogastric feedings of NeoSure 22 calorie formula to increase protein intake for possible protein losses through the impaired skin barrier. Toward the beginning of his hospital stay, an extensive pedigree of the family was done, and his family history was unremarkable. Therefore, we concluded that this patient would, in all likelihood, demonstrate a self-healing collodion phenotype.
During the 2nd week, the patient had diffuse peeling, especially in the facial area. Peeling around the eyes had also occurred, thus allowing him to close his eyes completely at this time. However, due to the persistent remnants of collodion membrane on his forehead, ammonium lactate treatment was continued so that his skin would completely exfoliate. On Day 27, the patient appeared pink, and his skin appeared to be much improved, but he still had significant edema of the lower extremities. On Day 29, the patient was started on a therapeutic amount of iron because he was found to have anemia with a hematocrit of 22.8% and absolute reticulocyte count of 76 k/
During his hospital stay, a 7-day course of Nafcillin and Gentamicin were given for abdominal wall cellulitis. He also received Vancomycin for suspected coagulase negative Staphylococcus (CONS) sepsis, but this was subsequently discontinued as it was thought to be contaminant.
We present the case of a male infant born as a Collodion baby, who after being placed in a humidified incubator and receiving expedient treatment with emollients and a prophylactic course of antibiotics, had a relatively uncomplicated hospital course. When the patient was 3 months of age, a 4 mm punch biopsy specimen was analyzed by a dermatopathologist. The presence of the granular layer and absence of dyskeratosis or acantholysis argued against ichthyosis vulgaris and epidermolytic hyperkeratosis. While lamellar ichthyosis and X-linked ichthyosis could have caused these changes, the working diagnosis was thought to be self-healing collodion baby since the patient’s family history was unremarkable. X-linked ichthyosis is a clinical manifestation of steroid sulfatase deficiency, an inborn error of metabolism. Although this diagnosis can be elucidated by examining hairs by light microscopy, we did not feel it was necessary to perform an immunohistochemical analysis.
Ichthyoses represent a heterogeneous group of skin disorders that are characterized by a generalized scaling of the skin due to defective cornification and desquamation. Children born with autosomal recessive congenital ichthyosis (ARCI) often present at birth as collodion babies. In 1985, Williams and Elias classified ARCI into two major types using clinical, histological, biochemical, and molecular genetic criteria: nonbullous congenital ichthyosiform erythroderma (NBCIE) and lamellar ichthyosis (LI) [
One important distinction between autosomal recessive congenital ichthyoses and other forms of ichthyoses is the age of onset of symptoms. Whereas the three types of autosomal recessive congenital ichthyoses typically present with collodion membrane or ichthyosiform erythroderma at birth, other forms of ichthyoses such as ichthyosis vulgaris and X-linked recessive ichthyosis manifest after birth. In some cases, extracutaneous symptoms could be diagnostic clues for recognizing special syndromes with associated ichthyoses including the following: Sjogren-Larsson syndrome, Netherton syndrome, Ichthyosis prematurity syndrome, Gaucher syndrome type 2, Keratitis-ichthyosis-deafness (KID) syndrome, Trichothiodystrophy, Dorfman-Chanarin syndrome, congenital hemidysplasia with ichthyosiform nevus and limb defects (CHILD) syndrome, ichthyosis follicularis, atrichia, and photophobia (IFAP) syndrome, and Conradi-Hünermann-Happle syndrome [
Due to mechanical compression, the parchment-like membrane in collodion babies may distort the features of the face and the extremities, giving the newborn a striking appearance that may initially frighten family members and physicians who may have never diagnosed such a case. The ears can appear malformed, the eyelids can be everted (ectropion), and the lips can be everted, giving a “fish mouth” appearance (eclabium) [
Unfortunately, none of these clinical features in a collodion baby can be used to predict the final diagnosis or prognosis of the underlying ichthyosis phenotype. In addition, since the diagnosis of collodion baby is a clinical one, examining histopathologic features of skin biopsy specimens in the first few weeks will not be useful in differentiating the different types of ichthyosis [