Collodion skin of the newborn.

Case 1.-Patrick G. was born on December 27, 1952, as a breech delivery and weighed 7 lb. It was the fourth pregnancy, the other children being alive and well except for the elder twin of the second pregnancy who died at 3 weeks of age from congenital hypertrophic stenosis of the pylorus. There was no history of ichthyosis in the family. At birth the infant cried readily but had a varnished appearance due to an almost complete covering of parchment-like skin. This was thickest over the anterior surface of the thorax and abdomen, less on the posterior surface, and absent over the head where covered with hair. The face was affected, causing a characteristic, unpleasant, immobile expression. The eyelids were sealed together and although the mouth and nostrils were patent they had a wrinkled and fissured appearance. The limbs were similarly affected and movements were restricted; the hair was normal as were the nails beneath their covering. Although the infant appeared immobile in his stiff casing, he had a vigorous cry and sucked well. Warm, sterile olive oil was applied daily to the surface of the body. Within two days the eyelids had partially separated giving a slit-eyed appearance; the eyes were normal. As the collodion-like coating hardened it began to crack, especially about the joints as the infant bame more active (Fig. IA). Likewise longitudinal cracks developed over the trunk, revealing a 'beefy', red appearance beneath. During the next two weeks the false skin peeled off leaving intact and normal skin underneath. Unfortunately, on the ninth day the left breast became flushed and a suppurative mastitis developed. This infection, caused by Staphylococcus aureus, responded to surgical drainage and streptomycin therapy. During the next few weeks three or four fine layers of papery scales desquamated readily from the head and axillae and slightly from the trunk. The infant thrived satisfactorily and at 14 months of age the skin appeared to be perfectly normal. The Wassermann reactions of the mother and child were negative. Histological examination of the membrane showed it to be composed of condensed layers of keratin. A biopsy of the skin was performed and Dr. J. E. Morison reported that the section showed no significant abnormality. The skin appendages were normally developed except perhaps for a slight dilatation of the orifices of the hair follicles and some slight retention of hyperkeratotic squamous debris.