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  1. 1. Slide 1 © 2003 By Default! HARLEQUIN ICHTHYOSIS a case report Dr. Shantanu Gomase 2nd year DNB Dept. Of Pediatrics J.L.N.H. Bhilai Steel Plant A Free sample background from
  2. 2. Slide 2 © 2003 By Default! Clinical details  Term  Male  2 kg  Normal delivery A Free sample background from
  3. 3. Slide 3 © 2003 By Default!  Head :Absence of hair Hyperkeratotic scale  Eyes: Severe ectropion is present. Conjuctival congestion  Pinna : Small and rudimentary.  Nose : Flattened  Lips: Severe traction on the lips A Free sample background from
  4. 4. Slide 4 © 2003 By Default! Skin: Severely thickened skin with large, shiny plates of hyperkeratotic scale. Deep erythematous fissures separate the scales. A Free sample background from
  5. 5. Slide 5 © 2003 By Default! A Free sample background from
  6. 6. Slide 6 © 2003 By Default! HARLEQUIN ICHTHYOSISThe term harlequin derives from the newborns facial expression and the triangular and diamond-shaped pattern of hyperkeratosis like that of a dress of harlequin clown.SYNONYMS : Ichthyosis congenita, keratosis diffusa fetalis, harlequin fetus . A Free sample background from
  7. 7. Slide 7 © 2003 By Default! Internationally more than 100 cases have been reported. Race: No racial predilection is known. Sex: No increased risk based on sex is known A Free sample background from
  8. 8. Slide 8 © 2003 By Default! GENETICS Mutations in the ABCA12 gene on chromosome no 2 cause harlequin ichthyosis. Autosomal recessive inheritance. This disorder occurs in consanguineous relationships and multiple siblings within a family can be affected. A Free sample background from
  9. 9. Slide 9 © 2003 By Default! CLINICAL FEATURESSKINSeverely thickened skin withlarge and shiny plates ofhyperkeratotic scale is presentat birth.Deep erythematous fissuresseparate the scales.EarsPinna may be small andrudimentary or absent. A Free sample background from
  10. 10. Slide 10 © 2003 By Default! EYESSevere ectropion is present.The free edges of the upperand lower eyelids are everted,leaving the conjunctivae atrisk for trauma. A Free sample background from
  11. 11. Slide 11 © 2003 By Default!LIPS: Severe traction on the lips causes eclabium and a fixed, open mouth.NOSE: Nasal hypoplasia and eroded nasal alae may occur. A Free sample background from
  12. 12. Slide 12 © 2003 By Default! PATHOGENESIS  All patients with harlequin ichthyosis have absent or defective lamellar granules and no intercellular lipid lamellae.  These granules are responsible for secreting lipids that maintain the skin barrier at the interface between the granular cell layer and the cornified layer.  The lipid abnormality is believed to allow excessive transepidermal water loss; lack of released hydrolases prevents desquamation, resulting in a severe retention hyperkeratosis A Free sample background from
  13. 13. Slide 13 © 2003 By Default! TREATMENT  Ensure airway, breathing, and circulation after delivery.  Place infants in a humidified incubator.  Monitor temperature, respiratory rate, heart rate, and oxygen saturation.  Maintain a sterile environment to avoid infection , IV Antibiotics A Free sample background from
  14. 14. Slide 14 © 2003 By Default!Intravenous access: Peripheral access is difficult. Umbilical cannulation may be necessary.Eye care: Ophthalmic lubricants to protect the conjunctivae.Skin care: Bathe infants twice daily. Use frequent applications of wet sodium chloride compresses followed by bland lubricants to soften hard skin and to facilitate desquamation A Free sample background from
  15. 15. Slide 15 © 2003 By Default! Fluid and electrolyte:  Intravenous fluids are almost always required  Consider excess cutaneous water losses in daily fluid requirement calculations.  Monitor serum electrolyte levels. A risk of hypernatremic dehydration exists. A Free sample background from
  16. 16. Slide 16 © 2003 By Default! Retinoids These agents decrease the cohesiveness of abnormal hyperproliferative keratinocytes. They modulate keratinocyte differentiation. Isotretinoin 0.5 mg/kg/d PO A Free sample background from
  17. 17. Slide 17 © 2003 By Default! COMPLICATIONS Gram-positive and gram-negative sepsis. Relapses of severe ichthyosis with eclabium and ectropion occur. Contractures and painful fissuring of the hands and the feet may occur without adequate topical or systemic therapy. A Free sample background from
  18. 18. Slide 18 © 2003 By Default! PROGNOSIS  Fulminant sepsis remains the most common cause of death in these infants.  Life expectancy is unknown: A report of survival to 9 years of age has been published.  Mortality/Morbidity: The mortality rate is high. With neonatal intensive care and the advent of retinoid therapy, some babies have survived they are still at risk of succumbing to systemic infection, which is the most common cause of death. A Free sample background from
  19. 19. Slide 19 © 2003 By Default! PRENATAL DIAGNOSIS Amniotic fluid samples obtained as early as 17 weeks’ gestation have demonstrated hyperkeratosis and abnormal lipid droplets within the cornified cells. Fetal skin biopsy can detect harlequin ichthyosis as early as 20 weeks’ gestation Antenatal USG can be used to identify harlequin ichthyosis but not until late in the second trimester when enough keratin buildup is present to be sonographically detectable. A Free sample background from
  20. 20. Slide 20 © 2003 By Default! THANK YOU A Free sample background from