The term, autosomal recessive congenital
ichthyosis (ARCI), describes a group of rare
genetic skin diseases of cornification involving hyperkeratotic scaling at birth. The defective skin barrier function may lead to
dehydration, body temperature instability, and high susceptibility to
infections. In most cases of ARCI, neonates are born with a
collodion membrane covering the body, often presenting with
ectropion and eclabium. We report a premature female neonate presenting with hyperkeratotic scaling at birth without a
collodion membrane. She was managed with placement in a humidified isolette, prophylactic
antibiotics, dilute bleach
baths,
petrolatum ointment, and
artificial eye drops. By the fourth week of life, there was marked improvement in her skin with the large, brown, plate-like scales on the trunk and extremities becoming lighter in color and finer in appearance. The
ichthyosis genetic panel showed mutations in the ABCA12 gene resulting in the
lamellar ichthyosis phenotype of ARCI. Our literature review revealed at least 28 patients with ARCI who were not born as
collodion babies. Although
collodion babies are a hallmark of most ARCI cases, clinicians should be aware of neonates with ARCI born without a
collodion membrane and expedite appropriate workup and treatment.