Successful Treatment of Collodion Baby with Acitretin: A Rep
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Collodion baby, a phenotypic diagnosis in a newborn, is covered with a parchment-like membrane all over the body. In some babies, the epidermal barrier is severely impaired leading to an increase in transepidermal water loss (TEWL), hypernatremic dehydration, poor feeding, failure to thrive and infections.

A 17-d-old (34 wk, 2.6 kg) male baby was admitted with a diagnosis of collodion baby with severe ectropion. He was nursed in an incubator with a relative humidity of 75%, gradually tapered over 7 d. Adequate analgesia with oral morphine and acetaminophen was provided for excessive stiffness and painful movements of the body. Paraffin dressing and topical antibiotics were applied to the skin. Ciprofloxacin and methylcellulose drops were used for the eyes. Oral acitretin 2 mg/kg/d was initiated after evaluation. At 4th wk, there was remarkable improvement. He was discharged on day 65 of life on full oral paladai feeds and alternate day acitretin. In second case a term female baby (2.8 kg) was admitted on day 2 of life with a similar presentation and course. She was managed on the same line as the first case.

The main goal of therapy is to decrease the TEWL by using temperature controlled humidified incubators (with 40 to 60% humidity that could be tapered over a period of time), optimizing the fluid, electrolyte and caloric intake and prevent sepsis. Early initiation of oral acitretin is highly beneficial in severe cases that dramatically improves the skin condition. Although the initial recommended dose of acitretin is 0.5 to 0.75 mg/kg/d ,the maximum dose of 2 mg/kg/d during the initial 6 wk was used, considering the severe ectropion in both the babies. Depending on the final outcome, the initial high dose can sequentially be tapered to a low maintenance dose of 0.25 mg/kg/d and slowly withdrawn.

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