A Case Report of a Collodion Baby: An Autosomal Recessive Genodermatosis

Congenital ichthyosis refers to various underlying genodermatoses that indicate prenatal epidermal abnormalities. Collodion babies are manifestations of rare congenital ichthyosis, comprising severe clinical complications that contribute to the risk of mortality. This case report presents the case of a full-term female neonate, delivered at 38 weeks of gestation, who exhibited features of a translucent collodion membrane over her entire body at birth. The mother reported fewer antenatal check-ups and a lack of obstetric ultrasonography during pregnancy. The baby later developed systemic complications, which were managed with intensive neonatal care. This case report attempts to address the uncommon occurrence of collodion babies, which can be managed with supportive care and diagnosed with a fair amount of certainty with invasive prenatal diagnostics.

Report of a Novel ALOX12B Mutation in Self-Improving Collodion Ichthyosis with an Overview of the Genetic Background of the Collodion Baby Phenotype

Collodion baby is a congenital, transient phenotype encountered in approximately 70–90% of autosomal recessive congenital ichthyosis and is an important entity of neonatal erythroderma. The clinical outcome after this severe condition is variable. Genetic mutations of components of the epidermal lipoxygenase pathway have been implicated in the majority of self-improving collodion ichthyosis (SICI). In SICI, the shedding of the collodion membrane reveals clear skin or only mild residual manifestation of ichthyosis. Here we report the case of a girl born with a severe form of collodion baby phenotype, whose skin almost completely cleared within the first month of life. At the age of 3 years, only mild symptoms of a keratinization disorder remained. However, the severity of erythema and scaling showed mild fluctuations over time. To objectively evaluate the skin changes of the patient, we assessed the ichthyosis severity index. Upon sequencing of the ALOX12B gene, we identified a previously unreported heterozygous nonsense mutation, c.1607G>A (p.Trp536Ter) with the recurrent, heterozygous mutation c.1562A>G (p.Tyr521Cys). Thereby, our findings expand the genotypic spectrum of SICI. In addition, we summarize the spectrum of further genetic diseases that can present at birth as collodion baby, in particular the SICI.

Two Italian Patients with ELOVL4-Related Neuro-Ichthyosis: Expanding the Genotypic and Phenotypic Spectrum and Ultrastructural Characterization

Elongation of Very Long Chain Fatty Acid-4 (ELOVL4) is a fatty acid elongase responsible for very long-chain fatty acid biosynthesis in the brain, retina, and skin. Heterozygous mutations in ELOVL4 gene cause Stargardt-like macular dystrophy and spinocerebellar ataxia type-34, while different homozygous mutations have been associated with ichthyosis, spastic quadriplegia, and mental retardation syndrome in three kindred. We report the first two Italian children affected with neuro-ichthyosis due to the previously undescribed ELOVL4 homozygous frameshift variant c.435dupT (p.Ile146TyrfsTer29), and compound heterozygous variants c.208C>T (p.Arg70Ter) and c.487T>C (p.Cys163Arg), respectively. Both patients were born with collodion membrane followed by development of diffuse mild hyperkeratosis and scaling, localized erythema, and palmoplantar keratoderma. One infant displayed mild facial dysmorphism. They suffered from failure to thrive, and severe gastro-esophageal reflux with pulmonary aspiration. The patients presented axial hypotonia, hypertonia of limbs, and absent head control with poor eye contact from infancy. Visual evoked potentials showed markedly increased latency and poor morphological definition, indicative of alteration of the retro-retinal visual pathways in both patients. Ultrastructural skin examination revealed abnormalities of lamellar bodies with altered release in the epidermal granular and horny layer intracellular spaces. Our findings contribute to expanding the phenotypic and genotypic features of ELOVL4-related neuro-ichthyosis.

Mutation update for CYP4F22 variants associated with autosomal recessive congenital ichthyosis

Autosomal recessive congenital ichthyosis (ARCI) is a heterogeneous group of rare disorders of keratinization characterized by generalized abnormal scaling of the skin. Ten genes are currently known to be associated with ARCI: TGM1, ALOXE3, ALOX12B, NIPAL4 (ICHTHYIN), ABCA12, CYP4F22, PNPLA1, CERS3, SDR9C7, and SULT2B1. Over a period of 22 years, we have studied a large patient cohort from 770 families with a clinical diagnosis of ARCI. Since the first report that mutations in the gene CYP4F22 are causative for ARCI in 2006, we have identified 54 families with pathogenic mutations in CYP4F22 including 23 previously unreported mutations. In this report, we provide an up-to-date overview of all published and novel CYP4F22 mutations and point out possible mutation hot spots. We discuss the molecular and clinical findings, the genotype-phenotype correlations and consequences on genetic testing.

Particularities of the management and the treatment in a rare sepsis with Candida tropicalis of a Collodion baby: Case report

RATIONALE

Collodion baby is a rare autosomal recessive disorder. It can be the first expression of some forms of ichthyosis.

PATIENT CONCERNS

The authors present the case of a newborn diagnosed with severe Collodion baby syndrome who required prolonged hospitalization in the intensive care unit because of infectious complications like the fungal sepsis and other bacterial superinfections.

DIAGNOSES

The case has many diagnostic and therapeutic particularities and management difficulties. Skin culture, dermatological and genetic exam were required.

INTERVENTIONS

The treatment required multidisciplinary involvement: neonatologist, pediatrician, geneticist, dermatologist, psychologist, ophthalmologist, audiologist.

OUTCOMES

The evolution during hospitalization was slowly favorable, but later, after a few months, it developed some complications.

LESSONS

In our case, skin injuries, total parenteral nutrition, aggressive and prolonged antibiotic therapy, intravenous devices, high hospitalization duration were risk factors for colonization and sepsis with fungi, especially in the neonatal period, sometimes with severe evolution and prognosis.

[Collodion baby: clinical aspects and role of prenatal diagnosis]

Le bébé collodion est une forme sévère de l’ichtyose congénitale à révélation néonatale. Le tableau clinique est souvent caractéristique. L’évolution, quand elle n’est pas fatale, se fait le plus souvent vers l’ichtyose sèche. Grâce aux techniques de biologie moléculaire, le diagnostic prénatal est rendu possible dès la 10-12^ème semaine d’aménorrhée, permettant un conseil génétique. Quant au pronostic de la maladie, il dépend de plusieurs paramètres, à savoir le degré de l’atteinte initiale, la durée de la desquamation, ainsi que l’ichtyose sous-jacente. A l’occasion d’une nouvelle observation d’un bébé collodion issu à 34 SA, d’une parturiente ayant un cas index, et a évolution fatale dés le premier jour de vie; nous avons fait une revue de la littérature afin de préciser les aspects diagnostiques et thérapeutiques ainsi que l’utilité du diagnostic anténatale.

Acral self-healing collodion baby: A case series

Collodion baby is a term used to describe a phenotype characterized by the presence of a tight, translucent membrane that covers the entire skin at birth. This membrane usually sheds around 10 to 14 days and reveals the underlying disease (mainly different types of Recessive Ichthyosis or other infrequent disorders). A rare variant of this phenotype is known as acral self-healing collodion baby whereby the patients are born with the typical membrane but limited to the hands and feet only, and after it sheds, the skin appears completely normal.

We report five cases of this very rare subtype of collodion baby. All the patient cases that are presented involved both hands and feet. One of the patients also had the umbilicus embedded in a subtle collodion membrane. None of the patients had a family history of the same entity or any other type of ichthyosis. In all patients, the condition resolved spontaneously within a few weeks and no patients developed any other manifestation. Although no molecular analysis was performed, we contribute to the knowledge of the clinical features of this extremely uncommon and benign entity, since to the best of our knowledge there are only two previous reports available in literature.

Myelodysplastic Syndrome Presenting as Amegakaryocytic Thrombocytopenia in a Collodion Baby

We report a rare case of myelodysplastic syndrome that presented early as amegakaryocytic thrombocytopenia in a collodion baby, which is a rare congenital disorder characterized by thick, taut membrane resembling oiled parchment or collodion, which is subsequently shed. To our knowledge, this is the first reported case of a collodion baby who presented with amegakaryocytic thrombocytopenia and who has a significant family history of the same condition. We document the rarity of this possible association and also the need for further study to establish whether a causal relationship exists.

Transglutaminase-1 mutations in Omani families with lamellar ichthyosis

OBJECTIVE

To determine the molecular basis of familial ichthyosis in three Omani families.

SUBJECTS AND METHODS

Nine patients from three consanguineous families, A, B, and C, were born with typical features of lamellar ichthyosis subtype including collodion membrane and maintained ectropion, and epidermal scaling through their childhood. The 4 patients from family B had more severe symptoms requiring neonatal critical care and subsequent regular treatment with emollients, eye lubricants, and low-dose acitretin. DNA was extracted from peripheral blood by standard methods. The samples were initially genotyped to screen known loci linked to recessive ichthyosis on chromosomes 2q33-32 (ABCA12), 14q11 (TGM1), and 19p12-q12 using commercially supplied polymorphic fluorescent microsatellite markers. TGM1 was analyzed by direct sequencing for disease-associated mutations.

RESULTS

Two known pathogenic mutations in TGM1 were detected: p.Gly278Arg in families A and B and p.Arg396His in family C. These two mutations were segregating in an autosomal recessive mode of inheritance.

CONCLUSION

Two known pathogenic TGM1 mutations were detected in three large consanguineous Omani families with lamellar ichthyosis. This study confirmed the geographic distribution of known mutations to an apparently unrelated population.