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The term harlequin fetus is used to describe an extremely severe form of skin disease in which affected infants have thick, plate-like scales all over their bodies. This abnormality is present from birth. It leads to disfiguration of the facial features and limited movement of the arms, legs, fingers, and toes. Most affected infants die during the first several weeks of life, although longer-term survivors have been reported.
Harlequin fetus represents the most severe presentation of inherited ichthyosis. The word ichthyosis, which is derived from the Greek word for fish, is a descriptive term used for a group of inherited disorders in which the skin is markedly thickened, ridged, and cracked. The term "harlequin ichthyosis" is therefore used interchangeably with "harlequin fetus." Other synonyms over time have included fetal ichthyosis, ichthyosis intrauterina, keratosis diffusa fetalis, congenital diffuse maligna keratoma, and malignant keratosis.
The ichthyoses as a group are due to a variety of underlying metabolic abnormalities. However, the net effect of each abnormality is the same: keratinization, or differentiation of the cells which make up the skin, does not occur normally. The ichthyoses are separated based on their clinical features and the age at which symptoms appear.
Ichthyosis of the newborn refers to those disorders that present either at birth or shortly thereafter. Each newborn ichthyosis may be due to a different genetic abnormality, even when there is some similarity between clinical features. The harlequin fetus, however, is such a distinct and striking disorder that it is rarely confused with other types of ichthyosis. Affected infants have thick, armor-like skin with deep cracks running in different directions all over their bodies. This gives the appearance of diamond-shaped plaques. The word "harlequin" is often used to describe a variegated pattern, or a combination of patches on a solid background of a contrasting color. The severe skin abnormality leads to an open, fish-mouth appearance as well as a turning outward of the eyelids. Abnormalities of the internal organs are uncommon but have been reported in some individuals. Death often occurs early due to severe skin infection.
Author Info: Terri A. Knutel MS, CGC, The Gale Group Inc., Gale, Detroit, Gale Encyclopedia of Genetic Disorders Part I, 2002This feature is for informational purposes only and should not be used to replace the care and information received from your healthcare provider. Please consult a healthcare professional with any health concerns you may have.
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