Isotretinoin, a Boon for Collodion Babies: A Case Series

Introduction: Ichthyoses are a group of disorders that include a wide spectrum of conditions varying in etiology, onset, intensity, and extent of involvement, with the common feature being abnormal keratinization. This ultimately leads to impaired barrier function of the skin. Collodion baby is a preceding manifestation of ichthyoses, described as a congenital condition characterized by the presence of a parchment or cellophane-like taut membrane encompassing the whole body. It is a rare occurrence, and the loss of barrier functions leads to high mortality rates in affected neonates. Case Presentation: Three cases of severe collodion babies with significant cutaneous involvement, ectropion, eclabium, electrolyte abnormalities, and raised total leukocyte count were selected. They were managed by a simple technique of administering an easily available retinoid — isotretinoin — admixed with sterile honey at a dose of 1 mg/kg/day, along with supportive management in the neonatal intensive care unit. Significant improvement was noted in all three neonates, with marked reduction in erythema, edema, scaling, and fissuring within 2 weeks of starting oral isotretinoin. Conclusions: Collodion baby is a condition in which a parchment-like membrane covers the entire neonate. The loss of barrier function exposes the baby to several severe adverse conditions, such as electrolyte imbalances, dehydration, and infections. Prompt measures to manage the babies effectively with a multidisciplinary approach involving a dermatologist, neonatologist, and ophthalmologist should be carried out. The membrane eventually sheds off in 4 - 5 days, revealing the underlying ichthyosis phenotype, which is mostly a form of autosomal recessive congenital ichthyosis (ARCI). Oral isotretinoin is an economical, easily available, and effective treatment option for severe collodion babies.