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The term collodion baby describes a newborn whose entire body surface is enveloped in a thick, taut, shiny membrane resembling a film of dried glue (collodion). It is not a disease entity in itself but is the first expression of some forms of ichthyosis (Table I). It is not to be confused with the serious ichthyosis, harlequin baby, in which the foetus appears to be wrapped in a hard, scaly "shell" and which can cause death in the first days of life. Some babies with X-related ichthyoses present with a collodion-like appearance in the neonatal period. Another differential diagnosis is restrictive dermopathy which causes generalised foetal akinesia and major intra-uterine growth retardation.
The skin of collodion babies is tight and shiny and causes a characteristic facial appearance with ectropion (eversion of the eyelids preventing them from closing), eclabium (eversion of the lips) and small, folded ears (Figure 1). The fingers have a distinctive gloved appearance and the dermatoglyphs are absent. The skin is stiff to the touch and the baby’s range of movement is limited because of joint flexion deformity. There are partial forms which affect the extremities only. Shedding starts rapidly after cracks appear in the skin folds.
The histological findings are of little diagnostic value : the membrane consists of an abnormal, orthokeratotic, compact and thick horny layer whose appearance is not specific to the genodermatosis in question.
There are two major difficulties associated with collodion baby :
— potentially life-threatening complications may arise during the neonatal period ;
— and the longer-term prognosis, which depends on the severity of the underlying genodermatosis .
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