COLLODION BABY

Abstract
Collodion Baby (CB) is rare dermatological condition with worldwide occurance of 1 : 300.000
birth, The term Collodion Baby (CB) refers to a newborn whose entire body is covered with an
adherent, supple, parchment like membrane. CB in an uncommon dermatological condition and
common manifestation of various hereditary condition including Harlequin Ichtyosis (HI),
Lamelar Ichtyosis (LI), NonBullous Congenital Ichtyosiform Erythroderma (NBCIE), and
Trichothiodystrophy Metabolic Disease and Endocrine Disease. We reported a case of CB that
was brought to our hospital with condition pasif movement and poor feeding. The neonate was
born aterm by multigravida mother with Sectio Caesaria procedure. the physical examination
showed partchment like membrane also thick scale covered all over the body with predominance
over the chest, abdomen and both of lower extremity. She admitted to the perinatology room on
incubator with humadity controlled. For daily bathing she used water (with or without mild
cleanser), and given topical treatment (e.g. urea, alpha hydroxy acid, lactid acid, propylene
glycol, vegetable oil, and retinoid topical). Infection prevention, keep the skin moist in the
humidified incubator, topical treatment, and feeding support can be effective in preventing
complications.

Introduction
Collodion Baby (CB) is rare dermatological condition with worldwide occurance of 1 :
300.000 birth, the incidance of newborns og Collodion Baby in Indonesia is unknown. Collodion
baby was first reported in 1884 by Hallopean. 1,8 The term Collodion Baby (CB) refers to a
newborn whose entire body is covered with an adherent, supple, parchment like membrane. The
condition is usually associated with ectropion,eclabium, hypotrichosis, hypoplastic nasal and
auricular cartilage, and pseudocontractures.2 CB in an uncommon dermatological condition and
common manifestation of various hereditary condition including Harlequin Ichtyosis (HI),
Lamelar Ichtyosis (LI), NonBullous Congenital Ichtyosiform Erythroderma (NBCIE), and
Trichothiodystrophy Metabolic Disease and Endocrine Disease. 3 Differentiation of this subtype
in the neonatal period is difficult. Skin histology in first week of life isn’t spesific. The final
diagnosis is by genetic analyses will help provide proper treatments and genetic counseling. 4 so
far, six genes was associated with motations of TGM1 (transglutaminase 1), which is TGM1
mediate cross link in the formation of the cell envelope during terminal differentiation of
epidermis.9,10,11 Although the collodion membrane is a transien condition, it can raise some
complication and can cause death in the first few weaks of neonatal life. These complication
include skin abnormalities (e.g. fissuring, bilateral ectropion, autoamputation of digits due to
constricting membrane, and limb swelling), ophtalmologic, gastrointestinal (e.g. poor weight,
constipation, gastroesophageal reflux), respiratory, and biochemical (e.g. hypernatremia,
hypocalcemia, and hypoglycemia). Placing the baby in humidified incubator is considered
essential. Management of Collodion Baby requires collaboration pediatriacian and dermatologist.
Most researchers recommend setting in the incubator humidity at 40 – 60%. Clinical
management also relies on daily bathing with water (with or without mild cleanser). 5,6 Topical
treatment such as urea, alpha hydroxy acids, mainly lactic acid, and propylene glycol, vegetable
oils such as petroleum jelly and topical retinoid are used. 7 Artificial tears may be needed in
severe ectropion condition.5 Enteral feeding start from the first day of life by nasogastric tube
and because of the high transdermal fluid loss, it is recommended intravenous fluid
250ml/kg/day.12 The case of Collodion Baby is still very rare in Indonesia and this is the first
case in our hospital.

Case presentation
A 3 day old female neonate came to Emergency Room with her parent with condition
pasif movement and poor feeding since yesterday. The neonate also have dry skin and membrane
wraps over the whole body, especially at her skin fold since birth. The neonate was born aterm
by multigravida mother with Sectio Caesaria procedure because of premature membrane rupture
and poor obstetric history with APGAR score 8-9, birtth weight of 2.940 gram, with length and
head circumference being 49 and 34 cm.
Vital sign in Emergency Room showed the neonate heart rate 130 times per minute,
respiratory rate of 35 minute per minute, and axilla temperature of 36,4°C. From the physical
examination showed partchment like membrane also thick scale covered all over the body with
predominance over the chest, abdomen and both of lower extremity. The neonate skin colour was
yellow from head to thigh. Other physical examination no signs of abnormalities were found.
According to the parent, there was no history of consanguinity or dermatological related
disorders in the family. There was no history of maternal complication during pregnancy or drug
maternal exposure. The neonate was the fourth pregnancy, with the first and thirs pregnancy
aborted and the second child now 4 years old.
The results of the initial laboratory test was Complete Blood Count reported white blood
cell 8.74 x 103 /µL, neutophils 45.4%, lymphocytes 40.8%, haemoglobin 15.9 g/dL, haematocrit
45.0%, and platelets 223.000, glucose level and electrolytes serum within normal ranges.
Pediatrician diagnosed with Collodion Baby and admitted to the perinatology room on incubator
with humadity controlled. Humidity of 60% in first week, humidity of 50% for next 3 days,
humidity of 40% for next 4 days, humidity 30% for next 1 day and the next 2 days in the crib.
Close monitoring of body temperature and adequate fluid was done. Breast feeding and by tube
was started since first day in perinatology room. Dermatologist diagnosed with Ichtyosis
Lamelar, suggest histopatology and pathology anatomy examination and given mixed cream
which contains of hydrocortisone 2.5% and chloramphenicol. Opthamologist said no abnormality
and given artificial tears twice a day for avoid dry eyes. And ENT Specialist also said no
abnormality.
The neonate bathed with special soap contain lactat acid, lactoserum, and pH for normal
skin. After bathed, neonate given mixed cream from Dermatologist in all over the body and next
2 hours after mixed cream, neonate given petroleum jelly for moisturize.
Other examination on neonate was chromosome analysis with the result was no found
major structural abnormalities. For histopathology and pathology anatomy examination weren’t
performed because the parent object in invasive action.
Finally after 17 days hospitalized, the neonate discharged from the hospital with good
general health condition. The neonate skin was look better than before, only appear in some area
with peeling of in the fore head, chest and abdomen.

Discussion
Collodion Baby is rare dermatological condition, whose entire body is covered with an adherent,
supple, parchment like membrane, and associated with ectropion, eclabium, hypotrichosis,
hypoplastic nasal and auricular cartilage, and pseudocontracture. 1,2 A 3 day old female neonate
come to hospital with dry skin and membran wraps over the whole body with predominance over
the chest, abdomen, and both of lower extremity. Other physical examination no sign of
abnormality were found. To diagnose Collodion Baby is by genetic analyses which of the result
of analyses can find the subtype and will help provide proper treatment and genetic counseling. 4
Complete blood count, serum elecrolytes, blood sugar level, and chromosome analyses was
performed in this case. On complete blood count, electrolytes serum, and blood sugar levels were
within normal limits and for the chromosome analyse wasn’t found major structural
abnormalities. Placing Collodion Baby in the humidified incubator is considered essential, with
the incubator humidity set on 40-60%. For daily bathing can use water (with or without mild
cleanser), and topical treatment (e.g. urea, alpha hydroxy acid, lactid acid, propylene glycol,
vegetable oil, and retinoid topical). And artficial tears may be need if the baby have ectropion. 2,5,6
In this case, everyday the neonate bathed with special soap which contain lactid acid, lactoserum,
and pH for normal skin, given artifical tears twice a day, given mixed cream from Dermatologist,
and 2 hours after mixed cream the neonate given petroleum jelly. Keep the skin of the neonate
moist by placing her in humidified incubator and several topical therapies, on the 16 th day the
neonate could move to the crib, and on the 17th day the neonate allowed to go to home with better
skin condition than before.

Conclusion
Collodion baby is a rare case in the world. Due the skin disorders, Collodion Baby is very risk of
complications and can cause death in the early weeks of life. By preventing infection, keeping
the skin moist in the humidified incubator and topical treatment, and feeding support can be
effective in preventing complications.

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