Congenital Ichyosis is relatively uncommon disease but is the most common cause of Collodian baby. Early diagnosis is required for immediate management and prevention of fluid-electrolyte balance as well as prevention of secondary infections. Definitive diagnosis is essential for long-term management as well as counselling to the parents of affected infant if they are considering having children together.
Case reportA full term male infant was born by spontaneous vaginal delivery to a 35 y/o, G5P4 woman. Her prenatal course, including prenatal ultrasound, was unremarkable.
Examination at birth:He had normal anthropometry with height, weight and head circumference being between 25 th to 75 th percentiles.Skin: Diffuse erythematous skin lesion with collodion membrane covering the chest and back, tight skin on upper and lower extremities, fissures on areas with skin folds, eversion of the eyelids with inability for complete eye examination, eversion of the lips, and malformation of the auricle.Tone and turgor: with in normal limit.
Heent:Anterior fontanelle: soft and flat, normal shape and size.
Eyes: Eversion of the eyelids.Ears: External malformation, unable to assess if secondary to skin lesions.Nose: Nares and septum appear with in normal limit.His cardiovascular, abdominal, spine, back, extremities and external gentile examinations were normal.On further evaluation, family history was not significant for any medical and dermatological conditions. There was no history of consanguinity. The patient has a 2 y/o healthy full sister. Mother was carrier for Cystic Fibrosis. He has two half-brothers (13 y/o and 10 y/o) from maternal side who has eczema, otherwise healthy; two half-sisters and one brother from paternal side-all reportedly healthy (Figure 1 and 2).
DiscussionCollodion baby is a severe form of Congenital Icthyosis. Congenital Icthyosis is heterogeneous group of disorders of cornification involving all or most of integumentary system [1] which is characterized by a generalized scaling of the skin of varying severity. Mucosal surface and visceral organs are generally spared. Cornification is process of terminal keratinocyte differentiation. At this stage, a lipid envelope is extruded into the intercellular space from lamellar bodies to form lipid sheets composed of ceramides, cholesterol, and free fatty acids [2].
Normal skin turnoverSkin has dermis and epidermis layers. Epidermis has four layersstratum basale, spinosum, granulosum, and corneum from base to top. During normal skin turnover of 28 days, site-relevant proteins and lipids are synthesized in different layers of epidermis.
Revised nomenclature and classification of inherited ichthyosesThe