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Case presentation

A female was born at 39 weeks gestation covered in a shiny, pink, taut, translucent membrane with edematous feet and hands. These findings are consistent with a collodion baby ( Fig. 1 ) . The infant was delivered by an uncomplicated cesarean section with APGARS of 9 and 9, at 1 and 5 min respectively. The parents had no family history of ichthyosis. The taut skin did not cause any peripheral vascular insufficiency or restrictive respiratory compromise.

Collodion membrane seen covering the patient’s body.

Ophthalmology consult noted slight ectropion of the eyelids causing mild lagophthalmos. We observed external auditory canal stenosis with a membranous layer blocking the meatus. The patient’s tympanic membranes were unable to be evaluated due to external auditory canal stenosis, and the infant failed otoacoustic emissions bilaterally ( Fig. 2 ). An auditory brainstem response test (ABR) was not performed because the risk of infection contraindicated the procedure . The increased risk of infection is secondary to the augmented likelihood of the membrane adhering to the electrode and denuding the epidermis upon removal.

External auditory ear canal obstructed due to collodion membrane.

A layer of Aquaphor® applied to the patient shortly after birth relieved some of the tautness. Initial supportive treatment also consisted of 60% humidified isolet, continued application of petroleum-based emollients over her skin, and erythromycin and lacrilube ointment to her eyes. Caloric and electrolyte supplementation and close monitoring for body temperature and signs of sepsis were continued.

At twenty days of life, the infant still presented with a thickened hyperkeratotic shiny membrane covering her face, bilateral ears, neck, trunk, and extremities while fragments of the membrane elements were beginning to slough off of her trunk secondary to desquamation that occurs from underlying infant movement. As the membrane shed, she was diagnosed with underlying ichthyosis. She was treated with a prolonged regimen of mineral oil and liquid paraffin drops for over a month along with intermittent suctioning of the external auditory canal in clinic as the shedding continued. Thereafter, the infant was able to pass otoacoustic emissions bilaterally and subsequent serial audiograms. Currently, she is progressing normally along her growth curve and has resolved auditory canal stenosis with no hearing difficulty or predisposition for otitis media/otitis externa.